Patients unresponsive to medical therapy may require advanced interventions.
—-
In 2019 Antony et al. compiled and discussed the current evidence available in treating head and facial pain. The strongest evidence for neuromodulation is for occipital nerve stimulation for migraine, vagus nerve stimulation for cluster headache and for migraine, sphenopalatine ganglion stimulation for cluster headache, and transcutaneous supraorbital and supratrochlear nerve stimulation for migraine. In addition, there is moderate evidence for occipital nerve stimulation in treating occipital neuralgia 1)
In 2017 Láinez and Guillamón stated that DBS has good results, but it is a more invasive technique and can generate serious adverse events. Occipital nerve stimulation (ONS) has good results, but frequent and no serious adverse events. Sphenopalatine Ganglion Stimulation (SPGS) is also efficacious in the acute and prophylactic treatment of refractory cluster headache. At this moment, ONS and SPG stimulation techniques are recommended as first-line therapy in refractory cluster patients. New recent non-invasive approaches such as the non-invasive Vagus nerve stimulation have shown efficacy in a few trials and could be an interesting alternative in the management of CH, but require more testing and positive randomized controlled trials 2) and conduct basic research in order to clarify the mechanism of action 3).