neurostimulation for refractory primary chronic headache disorders: a review

Headache is the commonest symptom seen in both primary and secondary care. Vast majority are primary i.e. for which no underlying cause has been detected. Tension Headaches, Migraine and Cluster Headaches are the most common primary headache disorders in the population. Although most of the primary headache disorders can be satisfactorily treated with both acute and preventive medications, those that are refractory to conventional treatment pose a great challenge to the headache physician. Moreover some patients are not able to use traditional treatment due to intolerance and co-morbidities. Neurostimulation is a treatment modality that has been used in other neurological disorders such as movement disorders, multiple sclerosis and chronic neuropathic pain and there has been emerging evidence to its usefulness in primary headache disorders. These range from being invasive treatments like deep brain stimulation to minimally invasive one like occipital nerve stimulators. Non-invasive neurostimulation is gradually emerging as a potential non-pharmaceutical option in managing primary headache disorders. The article reviews the evidence of Neurostimulation in primary headache disorders with a view to ascertain its efficacy and safety.