Background: Head and facial pain is a common and often difficult to treat disorder.
Routine treatments sometimes fail to provide acceptable relief, leaving the patient searching
for something else, including narcotics and surgery. Recently, neuromodulation has been
expanding to provide another option. Secondary to its potentially temporary nature and
relatively manageable risk profile, several reviews have suggested trialing neuromodulation
prior to starting narcotics or invasive permanent surgeries. There is evidence that
neuromodulation can make a difference in those patients with intractable severe craniofacial
pain.
Objectives: To provide a basic overview of the anatomy, epidemiology, pathophysiology
and common treatments of several common head and facial disorders. Furthermore, to
demonstrate the suggested mechanisms of neuromodulation and the evidence currently
existing for the use of neuromodulation.
Methods: A comprehensive review was performed regarding the available literature
through targeting articles reporting on the use of neuromodulation to treat pain of the head
and face.
Results: We compiled and discuss the current evidence available in treating head and facial
pain. The strongest evidence currently for neuromodulation is for occipital nerve stimulation
for migraine, transcutaneous vagal nerve stimulation for migraine and cluster headache,
sphenopalatine ganglion microstimulation for cluster headache, and transcutaneous
supraorbital and supratrochlear nerve stimulation for migraine. In addition, there is moderate
evidence for occipital nerve stimulation in treating occipital neuralgia.
Limitations: Neuromodulation has been trialed and is promising in several craniofacial pain
disorders; however, there remains a need for large-scale, randomized, placebo-controlled
clinical trials to further evaluate the efficacy and safety of most treatments. Much of the
current data relies on case reports without randomization or placebo controls.
Conclusions: With advancing techniques and technology, neuromodulation can be
promising in treating intractable pain of the head and face. Although more randomized
controlled trials are warranted, the current literature supports the use of neuromodulation in
intractable craniofacial pain.
Key words: Neuromodulation, headache, facial pain, craniofacial pain, migraine, cluster
headache, trigeminal neuralgia, occipital neuralgia, peripheral nerve stimulator, high cervical
spinal cord stimulator, peripheral nerve field stimulator
Central modulation in cluster headache patients treated with occipital nerve stimulation: an FDG-PET study