Percutaneous electrical nerve stimulation (PENS) therapy for refractory primary headache disorders: a pilot study

2019 ◽  
Vol 33 (6) ◽  
pp. 608-612 ◽  
Author(s):  
Mark W. Weatherall ◽  
Dipankar Nandi
Keyword(s):  
Pilot Study ◽  
Nerve Stimulation ◽  
Primary Headache ◽  
Headache Disorders ◽  
Electrical Nerve Stimulation ◽  
Primary Headache Disorders

scholarly journals Greater Occipital Nerve Stimulation via the Bion® Microstimulator: Implantation Technique and Stimulation Parameters Clinical Trial: NCT00205894

2009 ◽  
Vol 3;12 (3;5) ◽  
pp. 621-628 ◽  
Author(s):  
Terrence L. Trentman
Keyword(s):  
Nerve Stimulation ◽  
Primary Headache ◽  
Implantation Technique ◽  
Headache Disorders ◽  
Occipital Nerve ◽  
Primary Headache Disorders ◽  
Stimulation Parameters ◽  
Greater Occipital Nerve ◽  
The Mean ◽  
One Year

Background: Millions of patients suffer from medically refractory and disabling primary headache disorders. This problem has led to a search for new and innovative treatment modalities, including neuromodulation of the occipital nerves. Objectives: The primary aim of this study is to describe an implantation technique for the Bion® microstimulator and document stimulation parameters and stimulation maps after Bion placement adjacent to the greater occipital nerve. The secondary aim is to document outcome measures one year post-implant. Design: Prospective, observational feasibility study. Methods: Nine patients with medically refractory primary headache disorders participated in this study. Approximately 6 months after Bion insertion, stimulation parameters and maps were documented for all patients. At one year, outcome measures were collected including the Migraine Disability Assessment Score. Results: At 6 months, the mean perception threshold was 0.47 mA, while the mean discomfort threshold was 6.8 mA (stimulation range 0.47 – 6.8 mA). The mean paresthesia threshold was 1.64 mA and the mean usage range was 16.0. There were no major complications reported such as device migration, infection, or erosion. One patient stopped using her Bion before the 12-month follow-up visit. At one year, 7 of the 8 patients were judged as having obtained fair or better results in terms of reduction of disability; 5 patients had greater than a 90% reduction in disability. Limitations: Small, heterogeneous patient population without control group. Not blinded or randomized. Conclusion: The Bion can be successfully inserted adjacent to the greater occipital nerve in an effort to treat refractory primary headache disorders. This microstimulator may provide effective occipital stimulation and headache control while minimizing the risks associated with percutaneous or paddle leads implanted subcutaneously in the occipital region. Key words: Chronic headache, migraine, cluster headache, peripheral nerve stimulation

scholarly journals Vagus nerve stimulation for primary headache disorders: An anatomical review to explain a clinical phenomenon

Cephalalgia ◽  
2019 ◽  
Vol 39 (9) ◽  
pp. 1180-1194 ◽  
Author(s):  
Dylan Jozef Hendrik Augustinus Henssen ◽  
Berend Derks ◽  
Mats van Doorn ◽  
Niels Verhoogt ◽  
Anne-Marie Van Cappellen van Walsum ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Trigeminal Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Primary Headache ◽  
Solitary Tract ◽  
Headache Disorders ◽  
Primary Headache Disorders ◽  
Non Invasive ◽  
Stimulation Of

Background Non-invasive stimulation of the vagus nerve has been proposed as a new neuromodulation therapy to treat primary headache disorders, as the vagus nerve is hypothesized to modulate the headache pain pathways in the brain. Vagus nerve stimulation can be performed by placing an electrode on the ear to stimulate the tragus nerve, which contains about 1% of the vagus fibers. Non-invasive vagus nerve stimulation (nVNS) conventionally refers to stimulation of the cervical branch of the vagus nerve, which is made up entirely of vagal nerve fibers. While used interchangeably, most of the research to date has been performed with nVNS or an implanted vagus nerve stimulation device. However, the exact mechanism of action of nVNS remains hypothetical and no clear overview of the effectiveness of nVNS in primary headache disorders is available. Methods In the present study, the clinical trials that investigated the effectiveness, tolerability and safety of nVNS in primary headache disorders were systematically reviewed. The second part of this study reviewed the central connections of the vagus nerve. Papers on the clinical use of nVNS and the anatomical investigations were included based on predefined criteria, evaluated, and results were reported in a narrative way. Results The first part of this review shows that nVNS in primary headache disorders is moderately effective, safe and well-tolerated. Regarding the anatomical review, it was reported that fibers from the vagus nerve intertwine with fibers from the trigeminal, facial, glossopharyngeal and hypoglossal nerves, mostly in the trigeminal spinal tract. Second, the four nuclei of the vagus nerve (nuclei of the solitary tract, nucleus ambiguus, spinal nucleus of the trigeminal nerve and dorsal motor nucleus (DMX)) show extensive interconnections. Third, the efferents from the vagal nuclei that receive sensory and visceral input (i.e. nuclei of the solitary tract and spinal nucleus of the trigeminal nerve) mainly course towards the main parts of the neural pain matrix directly or indirectly via other vagal nuclei. Conclusion The moderate effectiveness of nVNS in treating primary headache disorders can possibly be linked to the connections between the trigeminal and vagal systems as described in animals.

scholarly journals Primary headache disorders

2019 ◽  
Vol 9 (3) ◽  
pp. 233-240 ◽  
Author(s):  
Peter J. Goadsby
Keyword(s):  
Cluster Headache ◽  
Nerve Stimulation ◽  
Controlled Trial ◽  
Preventive Treatment ◽  
Primary Headache ◽  
Migraine Treatment ◽  
Headache Disorders ◽  
Primary Headache Disorders ◽  
Trigeminal Nerve Stimulation ◽  
Episodic Cluster Headache

Purpose of reviewTo review 5 new areas in primary headache disorders, especially migraine and cluster headache.Recent findingsCalcitonin gene-related peptide (CGRP) receptor antagonists (gepants—rimegepant and ubrogepant) and serotonin 5-HT1F receptor agonists (ditans—lasmiditan) have completed phase 3 clinical trials and will soon offer novel, effective, well-tolerated nonvasoconstrictor options to treat acute migraine. CGRP preventive treatment is being revolutionized after the licensing of 3 monoclonal antibodies (MABs), erenumab, fremanezumab, and galcanezumab, with eptinezumab to follow, especially designed for migraine; they are effective and well tolerated. For patients seeking a nondrug therapy, neuromodulation approaches, single-pulse transcranial magnetic stimulation, noninvasive vagus nerve stimulation (nVNS), and external trigeminal nerve stimulation, represent licensed, well-tolerated approaches to migraine treatment. For the acute treatment of episodic cluster headache, nVNS is effective, well tolerated, and licensed; nVNS is effective and well tolerated in preventive treatment of cluster headache. The CGRP MAB galcanezumab was effective and well tolerated in a placebo-controlled trial in the preventive treatment of episodic cluster headache. Sphenopalatine ganglion stimulation has been shown to be effective and well tolerated in 2 randomized sham-controlled studies on chronic cluster headache. Understanding the premonitory (prodromal) phase of migraine during which patients experience symptoms such as yawning, tiredness, cognitive dysfunction, and food cravings may help explain apparent migraine triggers in some patients, thus offering better self-management.SummaryHeadache medicine has made remarkable strides, particularly in understanding migraine and cluster headache in the past 5 years. For the most common reason to visit a neurologist, therapeutic advances offer patients reduced disability and neurologists a rewarding, key role in improving the lives of those with migraine and cluster headache.

scholarly journals Spotlight on cervical vagus nerve stimulation for the treatment of primary headache disorders: a review

2018 ◽  
Vol Volume 11 ◽  
pp. 1613-1625 ◽  
Author(s):  
Ilana S. Lendvai ◽  
Ayline Maier ◽  
Dirk Scheele ◽  
Rene Hurlemann ◽  
Thomas M. Kinfe
Keyword(s):  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Primary Headache ◽  
Headache Disorders ◽  
Primary Headache Disorders

Long-Term Outcome in Occipital Nerve Stimulation Patients With Medically Intractable Primary Headache Disorders

2012 ◽  
Vol 16 (6) ◽  
pp. 557-564 ◽  
Author(s):  
Ann Chang Brewer ◽  
Terrence L. Trentman ◽  
Michael G. Ivancic ◽  
Bert B. Vargas ◽  
Alanna M. Rebecca ◽  
...  
Keyword(s):  
Nerve Stimulation ◽  
Primary Headache ◽  
Headache Disorders ◽  
Occipital Nerve Stimulation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Occipital Nerve ◽  
Primary Headache Disorders

Effects of external trigeminal nerve stimulation (eTNS) on laser evoked cortical potentials (LEP): A pilot study in migraine patients and controls

Cephalalgia ◽  
2017 ◽  
Vol 38 (7) ◽  
pp. 1245-1256 ◽  
Author(s):  
Eleonora Vecchio ◽  
Eleonora Gentile ◽  
Giovanni Franco ◽  
Katia Ricci ◽  
Marina de Tommaso
Keyword(s):  
Pilot Study ◽  
Nerve Stimulation ◽  
Migraine Without Aura ◽  
Anterior Cingulate ◽  
Evoked Responses ◽  
The Real ◽  
Sham Stimulation ◽  
Primary Headache Disorders ◽  
Transcutaneous Nerve Stimulation ◽  
The Right

Background Transcutaneous external supraorbital nerve stimulation has emerged as a treatment option for primary headache disorders, though its action mechanism is still unclear. Study aim In this randomized, sham-controlled pilot study we aimed to test the effects of a single external transcutaneous nerve stimulation session on pain perception and cortical responses induced by painful laser stimuli delivered to the right forehead and the right hand in a cohort of migraine without aura patients and healthy controls. Methods Seventeen migraine without aura patients and 21 age- and sex-matched controls were selected and randomly assigned to a real or sham external transcutaneous nerve stimulation single stimulation session. The external transcutaneous nerve stimulation was delivered with a self-adhesive electrode placed on the forehead and generating a 60 Hz pulse at 16 mA intensity for 20 minutes. For sham stimulation, we used 2 mA intensity. Laser evoked responses were recorded from 21 scalp electrodes in basal condition (T0), during external transcutaneous nerve stimulation and sham stimulation (T1), and immediately after these (T2). The laser evoked responses were analyzed by LORETA software. Results The real external transcutaneous nerve stimulation reduced the trigeminal N2P2 amplitude in migraine and control groups significantly in respect to placebo. The real stimulation was associated with lower activity in the anterior cingulate cortex under trigeminal laser stimuli. The pattern of LEP-reduced habituation was reverted by real and sham transcutaneous stimulation in migraine patients. Conclusions The present results could suggest that the external transcutaneous nerve stimulation may interfere with the threshold and the extent of trigeminal system activation, with a mechanism of potential utility in the resolution and prevention of migraine attacks.

scholarly journals Use of traditional medicine for primary headache disorders in Kuwait

2018 ◽  
Vol 19 (1) ◽  
Author(s):  
Jasem Y. Al-Hashel ◽  
Samar Farouk Ahmed ◽  
Fatemah J Alshawaf ◽  
Raed Alroughani
Keyword(s):  
Traditional Medicine ◽  
Primary Headache ◽  
Headache Disorders ◽  
Primary Headache Disorders
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