Técnicas de neuromodulación en la cefalea

The use of neuromodulation for the treatment of headache is not new; in fact, it uses dates back to Roman times. In the modern time, the use of electrical stimulation in the treatment of refractory headache disorders start with the use of occipital nerve stimulation in the occipital neuralgia and the hypothalamic stimulation (DBS) in cluster patients. Several series have been published evaluating the efficacy of DBS in the management of refractory cluster patients. Today DBS is considered a technique with good short and long–term efficacy results, but as very invasive procedure. Occipital nerve stimulation has been used in the treatment of chronic migraine with good results in open studies and no so impressive data in clinical trials. In trigeminal autonomic headaches, the results have been better and it could be one of the first line therapies in refractory cluster patients. One of the problems is that the rate of complications related with the device is not low. Another target for electrical stimulation has been the sphenopalatine ganglion with a new implantable microstimulator; the results in the first trial in cluster headache have been good with acute and potentially preventive effect and low rate of device related complications. A trial in migraine is ongoing. Other non–invasive neuromodulation technique like the transcutaneous vagus nerve stimulation has been tried in several headache syndromes with positive results and very good tolerability. Electrical stimulation plays a role in the treatment of refractory (invasive methods) and could be useful in usual (non–invasive) headache patients.