Central Mechanisms of Peripheral Nerve Stimulation in Headache Disorders

Bartsch, Thorsten; Goadsby, Peter J.

doi:10.1159/000323008

Cited by 49 publications

(44 citation statements)

References 75 publications

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“…Indeed, the mechanism by which peripheral neurostimulation works is unclear and probably involves a complex interplay between the central and peripheral nervous system. 2,3 Only a few practitioners at specialized centers routinely implant peripheral neurostimulatory devices, so it comes as no surprise that case studies in its use for craniofacial pain have been limited. Thus, we have shared our extensive experience with the use of trigeminal branch stimulation in the treatment of intractable craniofacial pain.…”

Section: Discussionmentioning

confidence: 99%

Trigeminal branch stimulation for the treatment of intractable craniofacial pain

Ellis¹,

Munne²,

Winfree³

2015

JNS

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OBJECT Trigeminal branch stimulation has been used in the treatment of craniofacial pain syndromes. The risks and benefits of such an approach have not been clearly delineated in large studies, however. The authors report their experience in treating craniofacial pain with trigeminal branch stimulation and share the lessons they have learned after 93 consecutive electrode placements. METHODS A retrospective review of all patients who underwent trigeminal branch electrode placement by the senior author (C.J.W.) for the treatment of craniofacial pain was performed. RESULTS Thirty-five patients underwent implantation of a total of 93 trial and permanent electrodes between 2006 and 2013. Fifteen patients who experienced improved pain control after trial stimulation underwent implantation of permanent stimulators and were followed for an average of 15 months. At last follow-up 73% of patients had improvement in pain control, whereas only 27% of patients had no pain improvement. No serious complications were seen during the course of this study. CONCLUSIONS Trigeminal branch stimulation is a safe and effective treatment for a subset of patients with intractable craniofacial pain.

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Section: Discussionmentioning

confidence: 99%

Trigeminal branch stimulation for the treatment of intractable craniofacial pain

Ellis¹,

Munne²,

Winfree³

2015

JNS

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“…10,27 With the possible exception of endogenous opiate release, the 'gate control theory' is in fact the most M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 14 tenable view. 2,12,16,21 This was advanced in 1965 by Melzack and Wall, who found that activation of non-noxious afferent Aβ fibers may inhibit the Aδ and C fibers that mediate nociceptive transmission. Both these fibers transmit active signals to the spinal cord and have connections with spongiocytes, which suppress transmission of nociceptive stimuli.…”

Section: Discussionmentioning

confidence: 99%

Migraine Prevention Using Different Frequencies of Transcutaneous Occipital Nerve Stimulation: A Randomized Controlled Trial

Liu

Dong

Wang

et al. 2017

The Journal of Pain

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“…It seems likely, given that peripheral distribution of the pain does not predict the outcome of stimulation, that ONS has an important central effect on the brain. 32 Six out of the eight patients initially undergoing this procedure had sufficient benefit to recommend the procedure to others and to make it an option for other neuromodulation approaches. 33 Longterm experience over more than two years demonstrated that device dysfunction almost always led to the return of attacks.…”

Section: Occipital Nerve Stimulationmentioning

confidence: 99%

Neuromodulatory Approaches to the Management of Medically Refractory Cluster Headache

May¹,

Goadsby²

2010

European Neurological Review

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Cluster headache (CH) is, by neurological standards, a relatively common condition that affects about one in 1,000 people, 1 although compared with other more common primary headaches such as migraine 2 it remains rare in practice. CH has been defined in the second edition of the International Classification of Headache Disorders 3 as involving recurrent attacks of severe pain on one side of the head for between 15 and 180 minutes, associated with cranial autonomic features such as lacrimation, conjunctival injection, nasal congestion or rhinnorhoea (see Table 1). This condition can be divided into episodic (ECH) and chronic (CCH) forms. A diagnosis of ECH requires at least two cluster periods lasting from seven days to one year separated by painfree periods lasting one month or longer, while a diagnosis of CCH requires attacks to occur for more than one year without remission or with remission lasting less than one month. CCH affects about 10% of CH patients. General aspects of therapy of the disorder are covered elsewhere. 4,5 While it is not directly germane to neuromodulatiuon approaches, an understanding of the broad issues in medical treatment serves as a useful backdrop against which to discuss newer approaches. CH is one of the trigeminal autonomic cephalalgias, 6 and their therapies are usefully considered to be background 7 as they also can be considered for these newer approaches. Who Is Suitable for Neuromodulation Approaches?It seems reasonable to suggest that neuromodulation approaches to the management of CH be employed in patients with medically intractable forms of the condition. While this is currently true, it reflects the relatively primitive state of current interventions. One should observe that as devices become less invasive, the threshold for their use will become lower. For the moment there is a proposed working definition of medically intractable CH. 8 The essential components are disabling headache that fails at least four preventative drugs, including two from the first three of verapamil, lithium, methysergide, melatonin, topiramate and gabapentin (see Table 2). These considerations are particular to CH and, naturally, generic considerations related to requirements for the devices -such as fitness for anesthesia -are part of the overall assessment of patient suitability. What Approaches Have Been Tried?In essence, two classes of neuromodulation have been explored in CH:peripheral and central. Prior to moving to stimulation approaches, the dreadful pain and disability of medically intractable CH lead to a number of destructive procedures. In principle, these seem unlikely to work if one considers CH as fundamentally being a brain condition. Moreover, they may cause both mortality and significant morbidity, and can induce further pain problems such as anaesthesia dolorosa. Neuromodulatory Approaches to the Management of Medically Refractory Cluster Headache AbstractThe trigeminal autonomic cephalalgias are a group of primary headache disorders characterised by unilateral trigeminal d...

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Central Mechanisms of Peripheral Nerve Stimulation in Headache Disorders

Cited by 49 publications

References 75 publications

Trigeminal branch stimulation for the treatment of intractable craniofacial pain

Trigeminal branch stimulation for the treatment of intractable craniofacial pain

Migraine Prevention Using Different Frequencies of Transcutaneous Occipital Nerve Stimulation: A Randomized Controlled Trial

Neuromodulatory Approaches to the Management of Medically Refractory Cluster Headache

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