Neurostimulation for Headache That Has Become Difficult to Treat

  • Thorsten Bartsch
Reference work entry


The acute and preventive medical treatment of patients with primary headache syndromes such as chronic migraine is challenging and side effects frequently complicate the course of medical treatment. Recently there has been considerable progress in neurostimulation techniques in medically intractable chronic headache syndromes. It is very well known that a non-painful stimulation of peripheral nerves can elicit analgesic effects. This phenomenon has been used in certain pain syndromes using non-invasive high- or low-frequency transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation (PENS/acupuncture-like TENS or AL-TENS), and spinal cord stimulation (SCS). The analgesic effect is critically dependent on the intensity of the electrical stimulation. In recent years, minimally invasive neurostimulation techniques and neuromodulatory techniques, such as transcranial magnetic stimulation, have also been applied to patients with chronic headaches. This chapter summarizes the current concepts and outcome data of neurostimulation and neuromodulatory approaches. The studies suggest suboccipital neurostimulation can have an effect even decades after onset of headaches thus representing a possible therapeutic option in chronic patients with headaches difficult to treat and that do not respond to any medication. In a subset of patients with chronic cluster headaches, hypothalamic deep brain stimulation may be a treatment option.


Deep Brain Stimulation Chronic Migraine Spinal Cord Stimulation Transcutaneous Electrical Nerve Stimulation Peripheral Nerve Stimulation 
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Copyright information

© Lifting The Burden 2011

Authors and Affiliations

  1. 1.Department of NeurologyUniversity Hospital Schleswig-Holstein, University of KielKielGermany

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