Cervical Spinal Cord Stimulation in Headache
Spinal cord stimulation (SCS) has been historically used for the treatment of chronic pain conditions including neuropathic spinal pain, complex regional pain syndrome (CRPS) and failed back surgery syndrome (FBSS). The application of cervical SCS in headache conditions derives from the vast unmet need for new treatments for the subgroup of patients with refractory chronic headache disorders; the lack of paraesthesia perception for certain stimulation waveforms (high-frequency and burst stimulations), which would give the opportunity to create reliable sham in new clinical trials; and the speculation that targeting structures of the spinal cord at the level of the trigemino-cervical complex could produce a more meaningful pain relief. Preliminary open-label data using tonic low-frequency and high-frequency stimulation of the high cervical spine gathered promising results. Furthermore, in expert-specialised multidisciplinary centres, the procedure seems safe and well tolerated.
In the future, studies on mechanisms of action and larger prospective open-label and ultimately sham-controlled trials will be required to define the role of SCS as a treatment option in patients with refractory headache disorders.
KeywordsSpinal cord stimulation Occipital nerve stimulation Refractory headache Chronic migraine Cluster headache High-frequency stimulation Burst stimulation
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