Invasive neurostimulation in facial pain and headache syndromes

Headache is a common reasons for patients to seek medical care. Migraine is the most common form of disabling primary headache that has been estimated to be the most costly neurological disorder in the European Community at more than €27 billion per year. While considerable developments have been made in understanding and treating primary headaches there remains a group of patients with difficult to treat headache problems. Facial pain is another complex pain problem and especially severe neuropathic facial pain with considerable deafferentation has been labelled “la bête noire” of pain surgery. Many of these headache and facial pain problems are refractory to pharmacotherapy. Interventional pain management using electrical stimulation techniques can be the solution for a selected portion of these patients. In this article we describe and discuss a “treatment ladder” from minimally invasive to more interventional stimulation techniques according to the diagnosis of the pain syndrome under consideration. For each type of procedure, indications, technique and complications are discussed based on the experience of the authors and a review of the literature.