Abstract
Purpose of ReviewWe reviewed the literature that explored the use of central and peripheral neuromodulation techniques for chronic daily headache (CDH) treatment.Recent FindingsAlthough the more invasive deep brain stimulation (DBS) is effective in chronic cluster headache (CCH), it should be reserved for extremely difficult-to-treat patients. Percutaneous occipital nerve stimulation has shown similar efficacy to DBS and is less risky in both CCH and chronic migraine (CM). Non-invasive transcutaneous vagus nerve stimulation is a promising add-on treatment for CCH but not for CM. Transcutaneous external trigeminal nerve stimulation may be effective in treating CM; however, it has not yet been tested for cluster headache. Transcranial magnetic and electric stimulations have promising preventive effects against CM and CCH.SummaryAlthough the precise mode of action of non-invasive neuromodulation techniques remains largely unknown and there is a paucity of controlled trials, they should be preferred to more invasive techniques for treating CDH.
Highlights
Despite numerous therapeutic advances in recent years, there are several unfulfilled needs in the acute and prophylactic care of primary headaches
BDI Beck Depression Inventory, CCH chronic cluster headache, CDH chronic daily headache, CH chronic headache, CM chronic migraine, DLPFC dorsolateral prefrontal cortex, CTTH chronic tension-type headache, HF high-frequency, M1 primary motor cortex, M migraineurs patients, MA migraine with aura, MIDAS migraine disability assessment, MO migraine without aura, MOH medication overuse headache, S1 primary somatosensory cortex, STAI State-Trait Anxiety Inventory, tDCS transcranial direct current stimulation, V1 primary visual cortex, VAS visual analogue scale pain, the number of daily attacks, and the percentage of responders up to 15 days after the intervention [25]
Because tDCS applied for 10 continuous days was able to increase the metabolism of the subgenual anterior cingulate cortex [46], an area previously involved in chronic drug-resistant CH response to treatment with implanted occipital nerve stimulation [47], Magis et al investigated the therapeutic efficacy of tDCS in patients with rCCH [48]
Summary
Despite numerous therapeutic advances in recent years, there are several unfulfilled needs in the acute and prophylactic care of primary headaches. Compared to the sham group, patients receiving real rTMS showed ↓ of pain intensity, frequency of attacks, analgesic overuse, and depressive symptoms during treatment and one month later
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