Table 6 Efficacy of neuromodulation strategies in migraine and cluster headache

Deep brain stimulation

Isolated reports, no consistent data

no RCT, available case series show significant reduction in attack frequency but with consistent side effects [22, 117,118,119]

Occipital nerve stimulation

conflicting results from 3 RCT [197,198,199]

no RCT, case series show 50% improvement in frequency and intensity [200, 201]

Sphenopalatine ganglion stimulation

no RCT, only anecdotal case reports available

RCT shows SPG electrical stimulation is effective in reducing intensity and frequency in refractory chronic cluster headache [203]

Vagus nerve stimulation

RCT shows effective as abortive treatment [208], slight benefit on migraine frequency in prophylaxis [209]

Conflicting results from RCT, more effective on episodic CH than refractory chronic CH

Transcranial magnetic stimulation

RCT shows benefit on migraine with aura [213]

no RCT, no systematic reports available

Supraorbital nerve stimulation

significant reduction in migraine frequency [214, 215]

no RCT, only isolated reports available, possible positive effect [216]