Expert Answer: What happens when all medication fails for Intractable Chronic Migraines?

When people ask me what can be done for disabling frequent headaches that no longer respond to medications, they usually follow this up with a question about my views on neurostimulation. Neurostimulation has been used to treat select, intractable chronic pain complaints by using devices to provide electrical shocks to specific nerve regions to help reduce pain. These therapies are generally used after many other, usually more effective treatments have failed and are not expected to dramatically reduce pain severity.

Neurostimulation has also been tested for the treatment of intractable headaches. Researchers at the Headache Research Unit of Liège University in Belgium recently wrote a review article suggesting that neurostimulation might be an option for patients with intractable headaches of several types, including chronic migraine, although most studies have tested neurostimulation in patients with intractable cluster headache. Treatments have included stimulation of occipital or vagus nerves and even deep-brain stimulation. Researchers from Dallas recently published data for seven patients suggesting that combining stimulation of occipital and supraorbital nerves may be effective for intractable migraine.

So, should you start looking for someone to get you started with neurostimulation? Probably not—at least not until you have had your headache treatment history reviewed to make sure that more effective treatments with longer track records of good use in migraine patients can't be tried. In many cases, there are treatments your doctor doesn't routinely use that might be effective. In other cases, the time you spent trying a medication wasn't long enough to give it an adequate chance to work or the combination of drugs you might have been taking could have prevented good effectiveness. Seeking a second opinion of what else you might do for your migraines from a multispecialty treatment group can be a good way to make sure different treatments are considered. For example, if you are evaluated by a multidisciplinary pain management team, the doctor may suggest medications or injections, while the nurse may address your sleep, diet, and weight issues, a physical therapist may provide exercises and manipulative treatments, and a psychologist relaxation and cognitive behavioral therapy. It's generally best to make certain your migraines really are intractable to a broad range of well established treatments before moving on the more experimental treatments like neurostimulation.

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