Neurostimulation for Neck Pain and Headache
Neurostimulation for Neck Pain and Headache
The use of PNS for treatment of medically refractory headache is an active area of investigation with promising preliminary results for certain headache populations such as TAC and ON where response rates range from 60% to 90% at long-term follow up. The efficacy of PNS for CM has not been definitively established despite 3 large RCTs. A larger question is whether for any patient the benefits of PNS outweigh the risks of a procedure that has a high rate of complications and high likelihood of reoperation with long-term use. Given the difficult patient population, and the refractory nature of the disease, implantation of PNS for medically resistant CDH is a reasonable option and may be preferred to other, more invasive procedures. Larger prospective randomized trials and detailed analysis of factors that predict success are needed to help select patients for PNS. There is also a scarcity of data on the costs of PNS in comparison of medical management or other surgeries. The need for effective treatment of medically refractory headache is high, and research efforts are ongoing.
Conclusion
The use of PNS for treatment of medically refractory headache is an active area of investigation with promising preliminary results for certain headache populations such as TAC and ON where response rates range from 60% to 90% at long-term follow up. The efficacy of PNS for CM has not been definitively established despite 3 large RCTs. A larger question is whether for any patient the benefits of PNS outweigh the risks of a procedure that has a high rate of complications and high likelihood of reoperation with long-term use. Given the difficult patient population, and the refractory nature of the disease, implantation of PNS for medically resistant CDH is a reasonable option and may be preferred to other, more invasive procedures. Larger prospective randomized trials and detailed analysis of factors that predict success are needed to help select patients for PNS. There is also a scarcity of data on the costs of PNS in comparison of medical management or other surgeries. The need for effective treatment of medically refractory headache is high, and research efforts are ongoing.
