Table 2 Comparison of neuromodulation approaches targeting hypothalamus in TNP, migraine, and CH
Technology/Approach | Condition | Laboratory-Level Research | Clinical Use |
|---|---|---|---|
Pharmacological Approaches | TNP | Tricyclic antidepressants, SNRIs, SST-antagonists, orexin receptor inhibitors, carbachol microinjection, GABAergic receptor inhibitors, α−2 adrenoceptor interactions [2, 10, 87, 165]. | None specified, but pharmacological agents like TCAs and SNRIs are widely used in clinical settings for TNP management [39, 156]. |
Migraine | Research on specific pharmacological agents targeting hypothalamic pathways such as Suvorexant (orexin receptor antagonist), glyceryltrinitrate, SST-receptor antagonist [10, 46, 70]. | Ergotamine and dihydroergotamine (DHE), beta-blockers, antiepileptic drugs, NSAIDs, SNRIs, Triptan, Erenumab, Galcanezumab, pituitary adenylate cyclase-activating peptide 1–38 (PACAP1-38) and casein kinase 1 delta (CKIδ) [138, 152, 176]. | |
CH | Investigations into hypothalamic involvement in CH pathogenesis using muscimol, gabazine, PACAP38, naratriptan [155]. | Medications like Verapamil, Topiramate, sumatriptan and corticosteroids are used [106]. | |
Optogenetic Stimulation | TNP | Optogenetic inhibition of the PH, stimulation of dopamine D2 receptors in A11 nucleus [82, 114]. | Currently limited to experimental models like CCI-ION rat model; not yet in clinical use. |
Migraine | There is a significant gap in optogenetic research targeting the hypothalamus in migraine pain models. Future research covering this gap might potentially reveal new therapeutic management. | No current clinical application; optogenetics is primarily research-focused at this stage. | |
CH | There is a significant gap in optogenetic research targeting the hypothalamus in CH pain models. Future research covering this gap might potentially reveal new therapeutic management. | Not in clinical use, remains a laboratory research tool. | |
Electrical Stimulation | TNP | DBS focusing hypothalamus in the TNP animal model is yet to be done. However, this could open a new strategic door for TNP management. | DBS has been used in patients with TNP [50] |
Migraine | Research on hypothalamic involvement in migraine modulation via DBS, rTMS [14]. | rTMS and DBS could be emerging treatments for refractory migraine; however, still under study. | |
CH | DBS of the hypothalamus was explored in animal models for understanding pain and autonomic pathophysiology [3]. | Hypothalamic DBS is a recognized treatment for refractory CH [31, 49, 91, 108, 173]. |