Neuromodulation of chronic headaches: position statement from the European Headache Federation

Paolo Martelletti; Rigmor H Jensen; Andrea Antal; Roberto Arcioni; Filippo Brighina; Marina de Tommaso; Angelo Franzini; Denys Fontaine; Max Heiland; Tim P Jürgens; Massimo Leone; Delphine Magis; Koen Paemeleire; Stefano Palmisani; Walter Paulus; Arne May

doi:10.1186/1129-2377-14-86

Neuromodulation of chronic headaches: position statement from the European Headache Federation

Paolo Martelletti, Rigmor H Jensen, Andrea Antal, Roberto Arcioni, Filippo Brighina, Marina de Tommaso, Angelo Franzini, Denys Fontaine, Max Heiland, Tim P Jürgens, Massimo Leone, Delphine Magis, Koen Paemeleire, Stefano Palmisani, Walter Paulus, Arne May

123 Citations (Scopus)

Abstract

The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even medically intractable. When a definitive lack of responsiveness to conservative treatments is ascertained and medication overuse headache is excluded, neuromodulation options can be considered in selected cases. Here, the various invasive and non-invasive approaches, such as hypothalamic deep brain stimulation, occipital nerve stimulation, stimulation of sphenopalatine ganglion, cervical spinal cord stimulation, vagus nerve stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and transcutaneous electrical nerve stimulation are extensively published although proper RCT-based evidence is limited. The European Headache Federation herewith provides a consensus statement on the clinical use of neuromodulation in headache, based on theoretical background, clinical data, and side effect of each method. This international consensus further gives recommendations for future studies on these new approaches. In spite of a growing field of stimulation devices in headaches treatment, further controlled studies to validate, strengthen and disseminate the use of neurostimulation are clearly warranted. Consequently, until these data are available any neurostimulation device should only be used in patients with medically intractable syndromes from tertiary headache centers either as part of a valid study or have shown to be effective in such controlled studies with an acceptable side effect profile.

Original language	English
Article number	86
Journal	The Journal of Headache and Pain Online
Volume	14
Number of pages	16
ISSN	1129-2377
DOIs	https://doi.org/10.1186/1129-2377-14-86
Publication status	Published - 2013

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Martelletti, P., Jensen, R. H., Antal, A., Arcioni, R., Brighina, F., de Tommaso, M., Franzini, A., Fontaine, D., Heiland, M., Jürgens, T. P., Leone, M., Magis, D., Paemeleire, K., Palmisani, S., Paulus, W., & May, A. (2013). Neuromodulation of chronic headaches: position statement from the European Headache Federation. The Journal of Headache and Pain Online, 14, [86]. https://doi.org/10.1186/1129-2377-14-86

Martelletti, P, Jensen, RH, Antal, A, Arcioni, R, Brighina, F, de Tommaso, M, Franzini, A, Fontaine, D, Heiland, M, Jürgens, TP, Leone, M, Magis, D, Paemeleire, K, Palmisani, S, Paulus, W & May, A 2013, 'Neuromodulation of chronic headaches: position statement from the European Headache Federation', The Journal of Headache and Pain Online, vol. 14, 86. https://doi.org/10.1186/1129-2377-14-86

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abstract = "The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even medically intractable. When a definitive lack of responsiveness to conservative treatments is ascertained and medication overuse headache is excluded, neuromodulation options can be considered in selected cases. Here, the various invasive and non-invasive approaches, such as hypothalamic deep brain stimulation, occipital nerve stimulation, stimulation of sphenopalatine ganglion, cervical spinal cord stimulation, vagus nerve stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and transcutaneous electrical nerve stimulation are extensively published although proper RCT-based evidence is limited. The European Headache Federation herewith provides a consensus statement on the clinical use of neuromodulation in headache, based on theoretical background, clinical data, and side effect of each method. This international consensus further gives recommendations for future studies on these new approaches. In spite of a growing field of stimulation devices in headaches treatment, further controlled studies to validate, strengthen and disseminate the use of neurostimulation are clearly warranted. Consequently, until these data are available any neurostimulation device should only be used in patients with medically intractable syndromes from tertiary headache centers either as part of a valid study or have shown to be effective in such controlled studies with an acceptable side effect profile.",

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AU - Martelletti, Paolo

AU - Jensen, Rigmor H

AU - Antal, Andrea

AU - Arcioni, Roberto

AU - Brighina, Filippo

AU - de Tommaso, Marina

AU - Franzini, Angelo

AU - Fontaine, Denys

AU - Heiland, Max

AU - Jürgens, Tim P

AU - Leone, Massimo

AU - Magis, Delphine

AU - Paemeleire, Koen

AU - Palmisani, Stefano

AU - Paulus, Walter

AU - May, Arne

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N2 - The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even medically intractable. When a definitive lack of responsiveness to conservative treatments is ascertained and medication overuse headache is excluded, neuromodulation options can be considered in selected cases. Here, the various invasive and non-invasive approaches, such as hypothalamic deep brain stimulation, occipital nerve stimulation, stimulation of sphenopalatine ganglion, cervical spinal cord stimulation, vagus nerve stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and transcutaneous electrical nerve stimulation are extensively published although proper RCT-based evidence is limited. The European Headache Federation herewith provides a consensus statement on the clinical use of neuromodulation in headache, based on theoretical background, clinical data, and side effect of each method. This international consensus further gives recommendations for future studies on these new approaches. In spite of a growing field of stimulation devices in headaches treatment, further controlled studies to validate, strengthen and disseminate the use of neurostimulation are clearly warranted. Consequently, until these data are available any neurostimulation device should only be used in patients with medically intractable syndromes from tertiary headache centers either as part of a valid study or have shown to be effective in such controlled studies with an acceptable side effect profile.

AB - The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even medically intractable. When a definitive lack of responsiveness to conservative treatments is ascertained and medication overuse headache is excluded, neuromodulation options can be considered in selected cases. Here, the various invasive and non-invasive approaches, such as hypothalamic deep brain stimulation, occipital nerve stimulation, stimulation of sphenopalatine ganglion, cervical spinal cord stimulation, vagus nerve stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and transcutaneous electrical nerve stimulation are extensively published although proper RCT-based evidence is limited. The European Headache Federation herewith provides a consensus statement on the clinical use of neuromodulation in headache, based on theoretical background, clinical data, and side effect of each method. This international consensus further gives recommendations for future studies on these new approaches. In spite of a growing field of stimulation devices in headaches treatment, further controlled studies to validate, strengthen and disseminate the use of neurostimulation are clearly warranted. Consequently, until these data are available any neurostimulation device should only be used in patients with medically intractable syndromes from tertiary headache centers either as part of a valid study or have shown to be effective in such controlled studies with an acceptable side effect profile.

U2 - 10.1186/1129-2377-14-86

DO - 10.1186/1129-2377-14-86

M3 - Journal article

C2 - 24144382

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VL - 14

JO - Journal of Headache and Pain

JF - Journal of Headache and Pain

M1 - 86

ER -

Neuromodulation of chronic headaches: position statement from the European Headache Federation

Abstract

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