Research Update on Alternative Migraine Treatments

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Spinal cord stimulation, neurotechnology, acupuncture, neurostimulation: all effective in treating migraine, headaches.
Spinal cord stimulation, neurotechnology, acupuncture, neurostimulation: all effective in treating migraine, headaches.

Calcitonin gene-related peptide (CGRP) antibodies offer attractive preventive treatment options for headaches and migraines, however few other pharmaceuticals are available, begging for the development of complementary approaches.

An article recently published in the Journal of Headache and Pain by Giorgio Lambru, MD, and colleagues reviewed the efficacy of high frequency spinal cord stimulation in chronic refractory primary headaches.1 The study included 7 patients who were non-responsive to several conventional medications as well as Botulinum toxin type A

Participants underwent a 2 week trial of the procedure, in which they had 1 or 2 leads placed in the epidural space in the thoracic region that was connected to an external stimulator, targeting the dorsal columns at the C2-C3 vertebral level. Upon successful completion of the trial period, leads were implanted permanently.

Four of the chronic migraine patients were considered to have a successful trial period, in which they had at least a 50% decrease in headache intensity or frequency. The researchers noted that all of these patients were thought to be overusing medication at the time. Two of the patients were also taking a daily preventive medication for their chronic headaches. 

The patients were followed up from 12 to 40 months after the procedure. All participants noticed improvements, with at least a 50% reduction in the monthly number of headaches and in the number of days they required pain medication. One of the patients was also able to stop using his preventive treatment. All the patients were given continuous stimulation and patients noticed worsening when they were turned off. There were no major side effects, except worsening of headache pain, which was thought to be due to a lead malfunction. 

Two patients with short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA syndrome) also had leads implanted. One of the patients described 70% relief while the other reported complete relief of attack. One patient with cluster headache who also had leads implanted reported approximately 50% relief.

High-frequency spinal cord stimulation is thought to modulate the trigemino-cervical complex in the dorsal columns at C2-C3 vertebral bodies. This modality may be more effective than occipital nerve stimulators, as it produces a more rapid response and is associated with fewer side effects.

Another complementary technique that has recently shown promising results is non-invasive neurotechnology that uses sound to alleviate migraines. The method may also help with blood pressure and heart rate variability.2 

This technique was presented during the American Heart Association's Council on Hypertension 2016 Scientific Sessions. Termed high-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM®), it uses sensors that measure electrical activity in the brain to detect differences between the 2 hemispheres.  

Presenting researcher Hossam A. Shaltout, RPh, PhD, of Wake Forest University in Winston-Salem, North Carolina believes that imbalance between the 2 sides of the brain may be a result of autonomic dysregulation due to chronic stress. Brain activity is reflected as audible tones which allow for regulation and balance between the 2 sides.

In a study (Abstract P602), the researchers examined the effect of HIRREM on 52 adults who had reported they suffered from migraines. After 16 sessions, patients noticed an improvement in headaches as well as mood and insomnia. Although this treatment is in preliminary phases, it may be a potential complementary option for patients with headaches with little risk of adverse effects.

Another group of researchers recently conducted a systematic review of evidence for the use of acupuncture in headache and migraine treatment. The analysis published in Headache, included nearly 5000 patients from 22 studies, comparing acupuncture treatment for at least 8 weeks with other migraine prophylaxis.3

The results revealed a minimum of a 50% reduction in headache intensity and a significant improvement in headache frequency, when compared to either routine care or prophylactic drug treatment at 2 months, although findings were not consistent in longer periods. 

Authors concluded acupuncture to be a viable treatment option for migraine in patients who do not tolerate or do well with prophylactic medications. Similar findings were obtained for the use of acupuncture for tension type headaches and chronic headaches. 

Finally, a review conducted by Todd Schwedt, MD and Bert Vargas, MD showed that neurostimulation may be useful as an adjunct to conventional headache and migraine therapies.4 These include transmagnetic stimulation, which is FDA-approved for the treatment of migraine with aura, along with transcutaneous supraorbital nerve stimulation.

Transcranial magnetic stimulation has been shown to be effective in treating multiple conditions in both chronic and episodic migraine.5 

In a time where there are only a few conventional therapies for migraine, many of which are not preferable to patients due to adverse effects, these complementary or adjunct therapies may prove to be useful.   

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References

  1. Lambru G, Trimboli M, Palmisani S, Smith T, Al-Kaisy, A. Safety and efficacy of cervical 10 kHz spinal cord stimulation in chronic refractory primary headaches: a retrospective case series. J Headache Pain.  2016;(17)66: 2-8.
  2. How “brainwave-balancing” therapy could ease migraines. Wake Forest School of Medicine. Last updated September 15, 2016. Accessed October 3, 2016.
  3. Coeytaux RR, Befus D. Role of acupuncture in the treatment or prevention of migraine, tension-type headache, or chronic headache disorders. Headache. 2016;56(7):1238-40.
  4. Schwedt TJ, Vargas B. Neurostimulation for treatment of migraine and cluster headache. Pain Med. 2015;16(9):1827-30.
  5. Bhola R, Kinsella E, Giffin N, et al. Single-pulse transcranial magnetic stimulation (sTMS) for the acute treatment of migraine: evaluation of outcome data for the UK post market pilot program. J Headache Pain. 2015;16(51):1-8.
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