Headache pain is generally divided into 4 separate types: migraines, cluster-type headaches, tension-type headaches, and secondary headaches (as a result of another condition or as a side effect of treatment). Each of these can be severe enough to impact daily life, and each of them can benefit from a treatment called neuromodulation.
Neuromodulation can be a biological process in which the body emits chemicals that regulate neural activity (e.g., serotonin, the “feel good” hormone), but in some cases a more surgical form of neuromodulation is needed. Surgical neuromodulation uses devices implanted along the spine, in the skull, or near a group of pain-causing nerves that then emit mild electrical pulses to disrupt the pain signals.
One example of this spinal cord stimulation.
With spinal cord stimulation (SCS), electrodes are positioned along the spine near the nerves that are the source of pain. A mild electrical impulse is then delivered to interfere with the body’s pain signaling, interrupting their path to the brain and offering pain relief. This is called neuromodulation in that the pain signals to the brain are interrupted, the neural circuit broken.
This neural disruption can be enacted directly in the brain itself with deep brain stimulation. Electrodes are implanted in the brain areas that receive pain signals, blocking the signals or correcting them to not signal pain. This technique has been used in the hypothalamus, the region from which tension-type and cluster headaches seem to stem, lending credence to the idea that these types of headaches are a result of sleep disorders or disturbances.
This technique may also work to help with cluster and nasal headaches associated with the sphenopalatine ganglion (SPG). 68% of patients in a clinical trial found relief from pain when a microstimulator was implanted in this nerve, but the duration of pain relief is still uncertain, and the risk at this time may outweigh the benefits. Patients may lose sensation and experience sensory disturbances as a result of treatment, and there is the risk of infection and tissue damage during implantation.
Less invasive forms of neuromodulation are called transcranial stimulation, and the most common form of this is transcutaneous electrical nerve stimulation (TENS).
During transcutaneous nerve stimulation, doctors place a cap or pads on the patient’s skull and deliver mild electrical current across the vagus nerve to trigger the release of pain-blocking signals. This has been a promising treatment for pain associated with migraine and cluster headaches.
Transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) are 2 other less-invasive neuromodulation techniques. The 1st has been used with success in the treatment of chronic migraines and the 2nd for episodic migraines. Both have very limited side effects and are promising treatments, but more research in larger clinical trials needs to be completed to truly judge their effectiveness.
Neuromodulation is a promising weapon in the arsenal against headache pain. Have you tried any of these techniques?
Image by Avenue G via Flickr