Neuromodulation in the Management of Headache Disorders
Rashmi Halker MD FAHS
With several invasive and noninvasive devices currently available or in trial, neuromodulation is emerging as a valuable headache treatment option for a variety of reasons. Most notably, the fact that these devices lack the side effects and drug interactions common to medication treatments make them an attractive choice for many individuals. Given the prevalence and disability associated with migraine and cluster headache, much of the research with neuromodulation has centered on these two primary headache disorders.
Single pulse transcranial magnetic stimulation (sTMS) and supraorbital nerve stimulation (SONS) are both noninvasive devices that are available for clinical use and approved for the treatment of migraine. Noninvasive vagus nerve stimulation (nVNS) has shown promise in the management of cluster headache. Given their noninvasive nature, these neuromodulatory tools can be considered as first-line treatment options. Conversely, more invasive neuromodualtion treatments, including occipital nerve stimulation (ONS) and sphenopalatine ganglion (SPG) stimulation, carry more risk and are reserved for refractory patients who have failed other treatments. Taken as a whole, neuromodulation remains an exciting new field with active research from a variety of vantage points, and promises to be a game changer in the way we manage headache disorders.
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Vagus nerve stimulation
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Single pulse transcranial magnetic stimulation
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Occipital nerve stimulation
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