Targeting pericranial nerve branches to treat migraine: Current approaches and perspectives

Abstract

Background: Migraine is a highly prevalent neurological disorders and a major individual and societal burden. Migraine is not curable at the present time, but it is amenable to acute symptomatic and preventive pharmacotherapies. Summary: Since the latter are frequently unsatisfactory, other treatment strategies have been used or are being explored. In particular, interventions targeting pericranial nerves are now part of the migraine armamentarium. We will critically review some of them, such as invasive and noninvasive neurostimulation, therapeutic blocks and surgical decompressions. Conclusions: Although current knowledge on migraine pathophysiology suggests a central nervous system dysfunction, there is some evidence that interventions targeting peripheral nerves are able to modulate neuronal circuits involved in pain control and that they could be useful in some selected patients. Larger, well-designed and comparative trials are needed to appraise the respective advantages, disadvantages and indications of most interventions discussed here.

Functional Changes of the Perigenual Part of the Anterior Cingulate Cortex after External Trigeminal Neurostimulation in Migraine Patients

“…Nowadays, neurostimulation may offer an alternative to pharmacological therapy in migraine, burdened by a number of contraindications and side effects (2, 3). Recently, the PREMICE trial (PREvention of MIgraine using Cefaly), a prospective, multicenter, double-blind, randomized, and sham-controlled trial provided evidence that eTNS is effective in migraine prevention and allows to reduce intake of abortive anti-migraine drugs (4).…”

“…There is thus a need for more effective and better tolerated treatments. Recently, based on new insights in migraine and pain pathophysiology, non-invasive neurostimulation therapies have raised much interest (2) Among them, interventions targeting pericranial nerves have become part of the preventive armamentarium (3). …”

“…More recently, a fluorodeoxyglucose-positron emission tomography (FDG-PET) study showed that eTNS with the Cefaly ® device was able to increase activity in crucial areas of the limbic system and salience matrix such as orbitofrontal (OF) and anterior cingulate cortex (ACC) in migraine patients responding to the treatment (8). This suggests that eTNS may be able to modulate neuronal circuits involved in the descending pain control of trigeminovascular nociceptors in the spinal trigeminal nucleus (3). Direct proof, however, of an eTNS-induced change in trigeminal nociceptive processing is lacking.…”

Identifying risk factors for rt-pa-related intracerebral hemorrhages in patients with acute stroke

“…pathways (40). Electrical nerve stimulation is a non-destructive method of pain control comprised of two types.…”

MR Neurography of Greater Occipital Nerve Neuropathy: Initial Experience in Patients with Migraine

“…The latter is hypothesized to result in triggered release of inflammatory and nociceptive peptides, which reach the meninges, inducing meningeal nociception and migraine. [6][7][8][9][10] A number of conservative and surgical peripheral nerve treatments have been reported for peripheral neuropathy (eg, perineural injections of steroids or onobotulinumtoxin A [Botox], radiofrequency ablation, and surgical decompression). [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] The greater occipital nerve (GON) is a sensory branch that arises from the dorsal ramus of the second cervical spinal nerve, 30 and its compression has been proposed as the etiology of clinically manifested occipital migraines.…”