Non invasive neuromodulation devices is safe, effective and well tolerated treatment options for migraine and cluster headache, as evident from the narrative review published in ‘Current Opinion of Neurology’. Single-pulse TMS, TMS, and nVNS devices have been approved by the US FDA for clinical use in the treatment of primary headache disorders.

Worldwide, headache is the sixth most common cause of disability. Due to its high prevalence, migraine accounts for a large proportion of this disability. A cluster headache, although less frequent, is very disabling due to the severity of pain during attacks. The most recommended acute and preventive medications may become ineffective due to its side effects, cause medication overuse headache, and are contraindicated in the setting of medical comorbidities such as cerebrovascular and cardiovascular disease. Also, there are limited treatment options for special populations including children, pregnant women, and older adults with medical comorbidities. There is a need for treatment modalities that are effective, safe with minimal side effects, have no risk of medication overuse headache, and have limited contraindications even in special populations. Noninvasive neuromodulation may be a viable treatment option to fill this void.

In this review, Starling A et al. provides a summary of the currently available non-invasive neuromodulation methods for the treatment of migraine and cluster headache. A number of clinical trials have been conducted to evaluate the efficacy and safety of non-invasive devices. Based on the results of these studies, United States Food and Drug Administration cleared the single-pulse transcranial magnetic stimulation, transcutaneous supraorbital neurostimulation, and non-invasive vagal nerve stimulation devices and made them available for clinical use for the treatment of primary headache disorders.

The author stated that the unique non-invasive devices are safe, well tolerated in both migraine and cluster headache. The study also provides an update of the proposed mechanisms of action, evidence, safety, and future directions of various currently available modalities of non-invasive neuromodulation.