**7. Conclusions**

Unfortunately, 70% of the patients suffer AEs, 40.7% of which require a new surgical procedure [29]. Some have combined the ONS with the SONS with ≥50% pain reduction in >70% of the patients [14]. The SCS has also been applied with 30% pain reduction in 50% of the

It is a very severe migraine variant, refractory to most known therapies and that often evolves to a very debilitating state. It has been treated with combined SONS and ONS with a 92% average decrease in the number of attacks [15]. The number of cases is limited, so further

TAC is a group of headache disorders characterised by unilateral headache accompanied by cranial autonomic symptoms. Although SONS has been attempted [19], ONS is the first

These consist of primary headache attacks associated with cranial autonomic dysfunction. In refractory cases, bilateral ONS induced a 69% pain improvement in 77% of the patients [93, 94]. Deep brain ventral tegmental area stimulation achieved a 78% headache rate improvement in almost all patients but with frequent AEs that at times required to explant

MTHI-H represents about 4% of the chronic headaches [112]. Transcranial magnetic stimulation has shown a 57% improvement in the intensity and frequency in this disorder [11–13]. SCS or GANS [37] stimulation has been used, stimulating the left prefrontal cortex [11]. In both cases, there was a 90% headache frequency reduction. Unfortunately, only two case

**6. Availability and usefulness of ambulatory techniques that can be** 

providers could choose not to pay for treatments that show moderate response.

All noninvasive procedures can be safely practiced at home. Their only drawback is low effectiveness, but they induce no harm in those in whom no beneficial results are obtained. Further studies are necessary. The AEs are minor and completely reversible once the device is no longer used. The biggest problem may arise from the economical point of view, as health

option [27], reserving the hDBS to the most recalcitrant cases [49, 50, 52].

**5.7. Mild traumatic head injury-related headache (MTHI-H)**

**5.6. Short-lasting unilateral Neuralgiform headache attacks with autonomic** 

**symptoms (SUNA) and short-lasting unilateral neuralgiform headache attacks with** 

cases [46].

**5.4. Hemiplegic migraine**

130 Transcranial Magnetic Stimulation in Neuropsychiatry

**5.5. Trigeminal autonomic cephalalgias (TACs)**

**conjunctival injection and tearing (SUNCT)**

reports exist, and no conclusions can be drawn.

studies are needed.

the system [49].

**practiced at home**

Although the immense majority of chronic headache disorders can be controlled with pharmacological means, there is a subset of patients that are refractory to all of them. A thorough diagnosis of the specific headache subtype is essential to provide an effective treatment. For those few refractory patients to the current available drugs, there are other treatment possibilities. We have now a wide array of noninvasive techniques that can be tried as a first attempt. In case of failure, surgically implanted stimulating systems can be of help. We should choose the more suitable option to the specific headache variant, keeping in mind the effectivity possible incidence of AEs of each treatment. hDBS should be considered the very last resource, as it is associated with some serious AEs and potentially to death.

