Peripheral Neuromodulation for the Management of Headache

Chronic pain is a common source of morbidity in many patient populations worldwide. There are growingconcerns about the potential side effects of currently prescribed medications and a continued need for effectivetreatment. Related to these concerns, peripheral nerve stimulation has been regaining popularity as a potentialtreatment modality. Peripheral nerve stimulation components include helically coiled electrical leads, whichdirect an applied current to afferent neurons providing sensory innervation to the painful area. In theory, theapplied current to the peripheral nerve will alter the large-diameter myelinated afferent nerve fibers, whichinterfere with the central processing of pain signals through small-diameter afferent fibers at the level of thespinal cord.The evidence for PNS in the head and neck region has largely focused on stimulation of the occipital nerves.The greater and lesser occipital nerves have long been a target for treatment of certain headache disorders andchronic posttraumatic pain. In many cases, stimulation has been used in headache patients, particularly thosesuffering from chronic migraines.In occipital neuralgia (ON), pain may occur in the distributions of the greater, lesser, or third occipital nerves andpatients frequently describe sharp, severe, and lancinating pain. The greater occipital nerve (GON) is stronglyimplicated in ON due to its circuitous course as it emerges from the suboccipital triangle.Multiple randomized trials have shown the benefit of occipital nerve stimulation for chronic migraine. Stimulationof occipital nerves may be offered to patients with chronic migraine headache when conservative treatmentshave failed. The average effect size for relief of migraine symptoms is modest to moderate (Level I, Grade B).

Keywords:

Acute pain , chronic pain , neuromodulation , peripheral nerve stimulation , headache