The appropriate use of neurostimulation: Stimulation of the intracranial and extracranial space and head for chronic pain

Timothy R. Deer, Nagy Mekhail, Erika Petersen, Elliot Krames, Peter Staats, Jason Pope, Youssef Saweris, Shivanand P. Lad, Sudhir Diwan, Steven Falowski, Claudio Feler, Konstantin Slavin, Samer Narouze, Lotfi Merabet, Asokumar Buvanendran, Felipe Fregni, Joshua Wellington, Robert M. Levy

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


Introduction The International Neuromodulation Society (INS) has identified a need for evaluation and analysis of the practice of neurostimulation of the brain and extracranial nerves of the head to treat chronic pain. Methods The INS board of directors chose an expert panel, the Neuromodulation Appropriateness Consensus Committee (NACC), to evaluate the peer-reviewed literature, current research, and clinical experience and to give guidance for the appropriate use of these methods. The literature searches involved key word searches in PubMed, EMBASE, and Google Scholar dated 1970-2013, which were graded and evaluated by the authors. Results The NACC found that evidence supports extracranial stimulation for facial pain, migraine, and scalp pain but is limited for intracranial neuromodulation. High cervical spinal cord stimulation is an evolving option for facial pain. Intracranial neurostimulation may be an excellent option to treat diseases of the nervous system, such as tremor and Parkinson's disease, and in the future, potentially Alzheimer's disease and traumatic brain injury, but current use of intracranial stimulation for pain should be seen as investigational. Conclusions The NACC concludes that extracranial nerve stimulation should be considered in the algorithmic treatment of migraine and other disorders of the head. We should strive to perfect targets outside the cranium when treating pain, if at all possible.

Original languageEnglish (US)
Pages (from-to)551-570
Number of pages20
Issue number6
StatePublished - Aug 2014
Externally publishedYes


  • Cranial nerve stimulation
  • deep brain stimulation
  • migraine
  • motor cortex stimulation
  • neurostimulation
  • occipital nerve stimulation
  • peripheral nerve stimulation
  • trigeminal nerve stimulation
  • vagal nerve stimulation

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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