Central neurostimulation techniques for primary headaches

Chronic pain has been correlated with changes in plasticity and excitability of the motor and somatosensory cortices and several other areas of the brain. These changes not only involve the cortical representation of the affected area but also localized neuronal excitability and distant circuits may be present. These findings created a foundation for the utilization of central neurostimulation to modulate the pattern of neuronal excitability in a wide variety of pain syndromes such as primary headaches. Treatment of primary headaches is of great importance due to the presence of significant disabling symptoms that impact patients' quality of life. Frequently, pharmacologic therapy is suboptimal and poorly tolerated leading to a real treatment challenge. Several non-pharmacologic strategies have been utilized successfully in the past several decades to manipulate the changes in plasticity and excitability of the cortex and other brain structures in painful conditions including headaches. Among available strategies, transcranial magnetic stimulation, transcranial direct current stimulation, and deep brain stimulation have acquired important attention in the management of headaches despite the highly variable level of evidence. This article provides an overview of the most relevant data on efficacy in central neurostimulation for primary headaches.