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Neuromodulation of chronic headaches: position statement from the European Headache Federation

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Abstract
The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even medically intractable. When a definitive lack of responsiveness to conservative treatments is ascertained and medication overuse headache is excluded, neuromodulation options can be considered in selected cases. Here, the various invasive and non-invasive approaches, such as hypothalamic deep brain stimulation, occipital nerve stimulation, stimulation of sphenopalatine ganglion, cervical spinal cord stimulation, vagus nerve stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and transcutaneous electrical nerve stimulation are extensively published although proper RCT-based evidence is limited. The European Headache Federation herewith provides a consensus statement on the clinical use of neuromodulation in headache, based on theoretical background, clinical data, and side effect of each method. This international consensus further gives recommendations for future studies on these new approaches. In spite of a growing field of stimulation devices in headaches treatment, further controlled studies to validate, strengthen and disseminate the use of neurostimulation are clearly warranted. Consequently, until these data are available any neurostimulation device should only be used in patients with medically intractable syndromes from tertiary headache centers either as part of a valid study or have shown to be effective in such controlled studies with an acceptable side effect profile.
Keywords
Medically intractable headache, Chronic headache, Neurostimulation, SPG, DBS, GON, tDCS, TMS, ONS, TENS, VNS, Migraine, Cluster headache, European headache federation, :CHRONIC CLUSTER HEADACHE, DEEP-BRAIN-STIMULATION, OCCIPITAL NERVE-STIMULATION, TRANSCRANIAL MAGNETIC STIMULATION, UNILATERAL NEURALGIFORM HEADACHE, SPINAL-CORD STIMULATION, HUMAN MOTOR CORTEX, POSTERIOR HYPOTHALAMIC AREA, VAGAL AFFERENT STIMULATION, ARTERIAL BLOOD-PRESSURE

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Citation

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MLA
Marteletti, Paolo, Rigmor H Jensen, Andrea Antal, et al. “Neuromodulation of Chronic Headaches: Position Statement from the European Headache Federation.” JOURNAL OF HEADACHE AND PAIN 14.1 (2013): n. pag. Print.
APA
Marteletti, P., Jensen, R. H., Antal, A., Arcioni, R., Brighina, F., de Tommaso, M., Franzini, A., et al. (2013). Neuromodulation of chronic headaches: position statement from the European Headache Federation. JOURNAL OF HEADACHE AND PAIN, 14(1).
Chicago author-date
Marteletti, Paolo, Rigmor H Jensen, Andrea Antal, Roberto Arcioni, Filippo Brighina, Marina de Tommaso, Angelo Franzini, et al. 2013. “Neuromodulation of Chronic Headaches: Position Statement from the European Headache Federation.” Journal of Headache and Pain 14 (1).
Chicago author-date (all authors)
Marteletti, Paolo, Rigmor H Jensen, Andrea Antal, Roberto Arcioni, Filippo Brighina, Marina de Tommaso, Angelo Franzini, Denys Fontaine, Max Heiland, Tim P Jürgens, Massimo Leone, Delphine Magis, Koen Paemeleire, Stefano Palmisani, Walter Paulus, and Arne May. 2013. “Neuromodulation of Chronic Headaches: Position Statement from the European Headache Federation.” Journal of Headache and Pain 14 (1).
Vancouver
1.
Marteletti P, Jensen RH, Antal A, Arcioni R, Brighina F, de Tommaso M, et al. Neuromodulation of chronic headaches: position statement from the European Headache Federation. JOURNAL OF HEADACHE AND PAIN. 2013;14(1).
IEEE
[1]
P. Marteletti et al., “Neuromodulation of chronic headaches: position statement from the European Headache Federation,” JOURNAL OF HEADACHE AND PAIN, vol. 14, no. 1, 2013.
@article{4240407,
  abstract     = {The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even medically intractable. When a definitive lack of responsiveness to conservative treatments is ascertained and medication overuse headache is excluded, neuromodulation options can be considered in selected cases.
Here, the various invasive and non-invasive approaches, such as hypothalamic deep brain stimulation, occipital nerve stimulation, stimulation of sphenopalatine ganglion, cervical spinal cord stimulation, vagus nerve stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and transcutaneous electrical nerve stimulation are extensively published although proper RCT-based evidence is limited. The European Headache Federation herewith provides a consensus statement on the clinical use of neuromodulation in headache, based on theoretical background, clinical data, and side effect of each method. This international consensus further gives recommendations for future studies on these new approaches.
In spite of a growing field of stimulation devices in headaches treatment, further controlled studies to validate, strengthen and disseminate the use of neurostimulation are clearly warranted. Consequently, until these data are available any neurostimulation device should only be used in patients with medically intractable syndromes from tertiary headache centers either as part of a valid study or have shown to be effective in such controlled studies with an acceptable side effect profile.},
  articleno    = {86},
  author       = {Marteletti, Paolo and Jensen, Rigmor H and Antal, Andrea and Arcioni, Roberto and Brighina, Filippo and de Tommaso, Marina and Franzini, Angelo and Fontaine, Denys and Heiland, Max and Jürgens, Tim P and Leone, Massimo and Magis, Delphine and Paemeleire, Koen and Palmisani, Stefano and Paulus, Walter and May, Arne},
  issn         = {1129-2369},
  journal      = {JOURNAL OF HEADACHE AND PAIN},
  keywords     = {Medically intractable headache,Chronic headache,Neurostimulation,SPG,DBS,GON,tDCS,TMS,ONS,TENS,VNS,Migraine,Cluster headache,European headache federation,:CHRONIC CLUSTER HEADACHE,DEEP-BRAIN-STIMULATION,OCCIPITAL NERVE-STIMULATION,TRANSCRANIAL MAGNETIC STIMULATION,UNILATERAL NEURALGIFORM HEADACHE,SPINAL-CORD STIMULATION,HUMAN MOTOR CORTEX,POSTERIOR HYPOTHALAMIC AREA,VAGAL AFFERENT STIMULATION,ARTERIAL BLOOD-PRESSURE},
  language     = {eng},
  number       = {1},
  pages        = {16},
  title        = {Neuromodulation of chronic headaches: position statement from the European Headache Federation},
  volume       = {14},
  year         = {2013},
}

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