Neurostimulation for Primary Headache Disorders, Part 1: Pathophysiology and Anatomy, History of Neuromodulation in Headache Treatment, and Review of Peripheral Neuromodulation in Primary Headaches


  • Conflict of Interest: Dr. Jenkins has no disclosures. Dr. Tepper receives research grants to the Cleveland Clinic from Autonomic Technologies, Inc, Boston Scientific, GSK, MAP, Merck, NuPathe, and Zogenix. He served as a consultant for GSK, MAP, Merck, Nupathe, and Zogenix. He served on the Speakers Bureau for GSK, Nautilus, Merck, and Zogenix. He served on an Advisory Board for Helsinn, Merck, MAP, Nautilus, Nupathe, and Zogenix.

S.J. Tepper, Cleveland Clinic, Headache Center, T33, 9500 Euclid Avenue, Cleveland, OH 44195, USA, email:


(Headache 2011;51:1254-1266)

Neurostimulation for primary headaches is being increasingly utilized as a treatment modality. Use of neuromoduation has generated multiple case reports as well as some controlled studies. This article is the first of 2 systematic reviews of available data regarding neurostimulation for primary headache conditions. The pathophysiology, relative anatomy, theoretical mechanisms, and history of neurostimulation for primary headache are covered in this section, Part 1 of 2. The literature regarding peripheral neurostimulatory targets is also reviewed in Part 1. These peripheral targets include: percutaneous nerves, transcranial holocephalic, occipital nerves, auriculotemporal nerves, supraorbital nerves, cervical epidural, and sphenopalatine ganglia. Part 2 will focus on central stimulation, covering vagus nerve, and deep brain stimulation. Part 2 also contains an overall analysis of efficacy, safety, cost, patient selection, and suggestions for further study based on available evidence.