Clinical Utility of Neuromodulation for Migraine Prevention and Treatment

According to a systematic review and meta-analysis, some neuromodulation methods appear to effectively treat symptoms of migraine; however, few studies of robust quality have been published. These findings were published in The Journal of Headache and Pain.

Publication databases were searched through July 1, 2020, for randomized clinical trials of neuromodulation methods for the treatment of migraine. This study included 38 articles, which were focused on preventive (n=31) and acute (n=7) treatments.

A single study reported 2-hour pain relief following remote electrical neuromodulation. Combined with 2 other studies, the benefit of remote electrical neuromodulation was confirmed (relative risk [RR], 2.14; 95% CI, 1.34-3.40).

Two studies examined transcutaneous electrical nerve stimulation as an add-on therapy or for migraine prevention. Both reported positive results, which were confirmed in the pooled analysis, but with a small effect size (-0.494; 95% CI, -0.799 to -0.188).

The use of vagus nerve stimulation was examined in 3 studies. Although no heterogeneity was found (I², 0%), this therapeutic failed to have a significant positive effect on migraine pain (effect size, -0.187; 95% CI, -0.379 to -0.004).

Percutaneous electrical nerve stimulation was tested by 3 studies, 2 of which used electroacupuncture, and 1 found moderate effects (1.5 days/month reduction in migraine). The pooled analysis returned a small but significant effect size (-0.344; 95% CI, -0.571 to -0.116).

The 3 studies that investigated invasive occipital nerve stimulation had positive results that were confirmed in the pooled analysis (effect size, -1.090; 95% CI, -1.977 to -0.204) but with high between-study heterogeneity (I², 88%).

Repetitive transcranial magnetic stimulation was examined by 6 studies. One study had positive results (3.2 days/month reduction in migraine), but the remaining studies did not have significant results when compared with placebo groups. The pooled analysis of high frequency repetitive transcranial magnetic stimulation (rTMS) over the left primary motor cortex showed a positive medium-sized effect, with moderate heterogeneity (effect size, -0.533; 95% CI, -0.940 to -0.126; I², 52%). The pooled analysis of high frequency rTMS over the left dorsolateral prefrontal cortex did not favor a positive effect, and revealed high heterogeneity between studies (− 1.210, 95%CI: − 2.844 to 0.423; I2 = 90%).

A total of 7 studies of transcranial direct current stimulation were included, but only 2 studies could be pooled for the meta-analysis, which indicated no effect for this treatment (effect size, -0.836; 95% CI, -1.764 to 0.091; I², 77%).

This study was limited by the lack of consistency of treatments among studies and the small overlap among therapeutics tested.

The study authors concluded there was evidence that some neurostimulation methods may be effective for preventive and acute treatment for migraines, especially invasive occipital nerve stimulation, supraorbital transcutaneous electrical nerve stimulation, percutaneous electrical nerve stimulation, high-frequency repetitive transcranial magnetic stimulation, and remote electrical neuromodulation. Larger, more robust studies are needed to confirm these findings.

Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.

Reference

Moisset X, Pereira B, Ciampi de Andrade DC, Fontaine D, Lantéri-Minet M, Mawet J. Neuromodulation techniques for acute and preventive migraine treatment: a systematic review and meta-analysis of randomized controlled trials. J Headache Pain. 2020;21(1):142. doi:10.1186/s10194-020-01204-4