Neurological

Scientific advantages of neuromodulation within the prevention and therapy of migraines

A systematic review and meta-analysis showed that some neuromodulation methods appear to be effective in treating symptoms of migraines. However, few studies of robust quality have been published. These results were published in the Journal of Headache and Pain.

By July 1, 2020, publication databases were searched for randomized clinical trials on neuromodulation methods for the treatment of migraines. This study included 38 articles, focusing on preventive (n = 31) and acute (n = 7) treatments.

A single study reported 2 hours of pain relief after electrical neuromodulation was removed. In combination 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 additional 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 investigated in 3 studies. Although no heterogeneity was found (I2, 0%), this therapeutic agent had no significant positive effect on migraine pain (effect size -0.187; 95% CI -0.379 to -0.004).

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

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

Repeated transcranial magnetic stimulation was investigated in 6 studies. One study had positive results (reducing migraines by 3.2 days / month), but the remaining studies showed no significant results compared to placebo groups. The pooled analysis of repetitive transcranial radiofrequency 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 the high-frequency rTMS over the left dorsolateral prefrontal cortex showed no positive effect and showed a high degree of heterogeneity between the studies (- 1.210, 95% CI: – 2.844 to 0.423; I2 = 90%).

A total of 7 studies on transcranial direct current stimulation were included, but only 2 studies could be combined 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 between studies and the small amount of overlap between the therapeutics tested.

The study’s authors concluded that there is evidence that some neurostimulation methods may be effective in preventive and acute treatment of migraines, particularly invasive occipital nerve stimulation, supraorbital transcutaneous electrical nerve stimulation, percutaneous electrical nerve stimulation, high frequency repetitive electrical transcranial magnetic stimulation, and distant electrical stimulation Neuromodulation. Larger, more robust studies are needed to confirm these results.

Disclosure: Several authors have stated that they are part of the pharmaceutical industry. For a full list of the details, see the original article.

reference

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

This article originally appeared on Clinical Pain Advisor

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