Non-Invasive Neurostimulation Methods for Acute and Preventive Migraine Treatment—A Narrative Review

Abstract

Neurostimulation methods have now been studied for more than 20 years in migraine treatment. They can be divided into invasive and non-invasive methods. In this narrative review, the non-invasive methods are presented. The most commonly studied and used methods are vagal nerve stimulation, electric peripheral nerve stimulation, transcranial magnetic stimulation, and transcranial direct current stimulation. Other stimulation techniques, including mechanical stimulation, play only a minor role. Nearly all methods have been studied for acute attack treatment and for the prophylactic treatment of migraine. The evidence of efficacy is poor for most procedures, since no stimulation device is based on consistently positive, blinded, controlled trials with a sufficient number of patients. In addition, most studies on these devices enrolled patients who did not respond sufficiently to oral drug treatment, and so the role of neurostimulation in an average population of migraine patients is unknown. In the future, it is very important to conduct large, properly blinded and controlled trials performed by independent researchers. Otherwise, neurostimulation methods will only play a very minor role in the treatment of migraine.

Long-term prophylactic efficacy of transcranial direct current stimulation in chronic migraine. A randomised, patient-assessor blinded, sham-controlled trial

“…In a recent narrative review, it was concluded that the data on the prophylactic efficacy of tDCS in CM were conflicting [16]. This has already been discussed previously, and the positive results of the present study can be explained by the homogeneity of our population, despite the limitation of the sample size.…”

“…In CM, central sensitization or long-term changes in brain plasticity may alter the modulatory systems of nociception [4][5][6][7][8][9][10]. These alterations have led to develop, for prophylactic purpose, invasive and non-invasive neuromodulation techniques such as occipital nerve stimulation (ONS), repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) [11][12][13][14][15][16][17]. ONS involves a surgical implantation of electrodes and pulse generator by a specialized team, while rTMS requires costly equipment and iterative hospital sessions for the patients.…”

“…Therefore, there is a rationale to propose a-tDCS of the left motor cortex as a therapeutic approach in migraine. Some encouraging results have been published [12,16,[34][35][36]. However, the current level of evidence of the therapeutic effect of tDCS protocols in migraine remains low [19].…”

fMRI findings in cortical brain networks interactions in migraine following repetitive transcranial magnetic stimulation

“…One of high-potential alternative approaches to treatment of migraine is neurostimulation [4] and particularly repetitive transcranial magnetic stimulation (rTMS) [5]. The efficacy of this method has been confirmed for acute and preventive migraine treatment [6,7]. Another significant advantage of TMS is the absence of side effects [8].…”

“…The existing paradigms of TMS efficacy in depression [11] and secondary headaches [12] are based on the application of neuroimaging methods, particularly functional magnetic resonance imaging (fMRI) which is a promising tool for assessing interactions of the brain's neural networks in migraine patients as well [13][14][15]. As we know, migraine is characterized by various changes in functional connectivity (FC) in the brain's neural networks, which mostly result in pain perception disorder and the inadequate response to pain [16].…”