Neuromodulation for Migraine Disorders

Many patients have severe, disabling migraines that are refractory to medical management. Various neuromodulation techniques have demonstrated efficacy for both prevention of migraines and treating acute symptoms. A literature search was performed to identify available neurostimulation-based treatments for migraines. The efficacy and literature supporting each of these methods are assessed and summarized in this chapter. Occipital nerve stimulation has high-quality evidence supporting its use as a preventive therapy. Supraorbital and supratrochlear nerve stimulation has high-quality evidence supporting its use for both prevention of migraines and as a rescue medication. Vagus nerve stimulation has had conflicting results in studies; however, it remains a low-risk, noninvasive treatment option for patients. Newer modalities (high-cervical spinal cord stimulation, transcranial direct current stimulation, and repetitive transcranial magnetic stimulation) have demonstrated promising results in preliminary studies. Each of these six neuromodulation techniques is discussed in detail in the chapter. Several different neuromodulation techniques are available for treatment of migraines in medically refractory patients.