Format

Send to

Choose Destination
See comment in PubMed Commons below
Neurol Sci. 2008 May;29 Suppl 1:S59-61. doi: 10.1007/s10072-008-0889-2.

Therapeutic neurostimulation in chronic headaches: problems of patient selection.

Author information

  • 1Headache Centre, National Neurological Institute (IRCCS) Foundation C. Besta, Via Celoria 11, 20133 Milan, Italy. leone@istituto-besta.it

Abstract

Chronic daily headache that does not respond or no longer responds to prophylaxis is commonly encountered at specialist headache centres. Animal and brain imaging studies indicate that peripheral neurostimulation affects brain areas involved in pain modulation, providing a rationale for its use in these conditions. We examine problems related to the selection of chronic daily headache patients for peripheral neurostimulation. These conditions are often associated with analgesic (including opioid) overuse, and psychiatric or other comorbidities, and the terms used to describe them (chronic migraine, transformed migraine, chronic daily headache and chronic tension-type headache) are insufficiently informative about these patients when proposed for neurostimulation. Longitudinal studies indicate that pre-existing subclinical depressive and anxious states play a key role in chronicisation and that the probability of responding to treatment is inversely related to headache frequency. These considerations suggest the need for extensive characterisation of patients proposed for neurostimulation. We propose that patients being considered for neurostimulation should be followed for at least a year, and that their headache over this time should consistently be frequent (all or most days) and drug refractory. We also propose that only completely drug-resistant (as opposed to partially drug-resistant) patients be considered for neurostimulation unless there are other indications.

PMID:
18545899
DOI:
10.1007/s10072-008-0889-2
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Springer
    Loading ...
    Support Center