Emerging Neuromodulation Techniques for the Treatment of Post-Traumatic Cephalalgias

DESCRIPTION

According to the CDC, in 2015 alone, 2.5 million traumatic brain injuries occurred in the United States. While TBIs can vary in severity and symptomatology, one common complaint after most TBIs is post-traumatic headaches (PTH) or cephalalgias. In fact, studies have shown that most patients with TBIs have PTH, regardless of severity at some point post-injury. The incidence of PTH in mild TBIs has been reported to be as high as 70-90%. PTH can often be one of the most disabling and enduring impairments associated with brain, cranial and/or cervical injuries, often affecting quality of life and return to employment post injury. Adding to the complexity facing providers trying to treat these patients is the fact that there are many types of PTH and identifying the type may be difficult. In fact, often patients following trauma may have multiple headache pain generators.

Treatment of post-traumatic cephalalgias has historically relied on “”shotgun”” approaches to pain management including use of opiates, overutilization of antimigraine medications, behavioral interventions and/or use of varied physical modalities some of which have very little scientific validation in the contest of PTH management. Often treatment is only partially effective or not effective at all. sometimes this is a result of an inaccurate diagnosis due to inadequate history taking and/or examination and over-reliance on ICDH-3. Even when appropriately diagnosed certain types of headaches may be unresponsive to even appropriate treatments. In an attempt to find relief, many patients are often over medicated and even develop medication over-use headache or medication induced headaches.

An exciting new area in headache management is that of neuromodulation; although, few practioners are aware of such advance. This pre-congress session will introduce and review the literature on some of the new non-invasive and minimally invasive neuromodulation treatments that are now being used or proposed to treat headaches, including post-traumatic headaches. We will introduce Cefaly, an FDA approved commercially available transcutaneous supraorbital nerve stimulator for the treatment of migraine prevention which is also being used in other applications. Other techniques for PTH management such as transcutaneous vagal nerve stimulation, sphenopalatine ganglion stimulation, transcranial magnetic stimulation, transcranial direct stimulation and cranial electrical stimulation will all be explored. FDA approved and off label use of these techniques/products will be examined and some of the panel will share their experience with a few of these techniques. It is important that providers who treat post traumatic headaches be made aware of and understand what the field of neuromodulation has to offer and may have in store for them and their patients with PTH.

LEARNING OBJECTIVES

  • Review subtypes of PTHA and treatment challenges.
  • Introduce the concept of neuromodulation for PTHA treatment.
  • Discuss various neuromodulation techniques including cranial electrical stimulation, trigeminal nerve stimulation techniqes, vagal nerve stimulation, TDCS. TMS and spenopalantine stimulation.
  • Review the theoretical underpinnings of neuromodulation efficacy for PTHA
  • Understand the research currently available on neuromodulation techniques for headache.
  • Demonstrate neuromodulation devices for audience participants.

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