The visual system as target of non-invasive brain stimulation for migraine treatment: Current insights and future challenges

Lau, Chi Ieong; Chen, Wei‐Hung; Walsh, Vincent

doi:10.1016/bs.pbr.2020.05.018

Cited by 5 publications

(5 citation statements)

References 225 publications

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“…Several lines of evidence indicate that migraine is characterized by an altered visual cortex excitability both during and between attacks [8]. Electroencephalography (EEG) studies have largely demonstrated that brain oscillations under multimodal and particularly visual stimuli are different in migraine patients compared with controls [9,10].…”

Section: Open Accessmentioning

confidence: 99%

Central effects of galcanezumab in migraine: a pilot study on Steady State Visual Evoked Potentials and occipital hemodynamic response in migraine patients

et al. 2022

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Background The discovery of the prominent action of Calcitonin Gene Related Peptide –CGRP- on trigeminal afferents and meningeal vessels, opened a new era in migraine treatment. However, how the block of nociceptive afferents could act on central mechanisms of migraine is still not clear. In this pilot study we aimed to test the effect of 3 months Galcanezumab (CGA) therapy on occipital visual reactivity in migraine patients, using the Steady State Visual Evoked Potentials-SSVEPs and Functional Near Infrared Spectroscopy –fNIRS. Method Thirteen migraine patients underwent clinical and neurophysiological examination in basal condition (T0), 1 h after GCA injection (T1) and after 3 months of GCA treatment (T2). Ten healthy volunteers were also evaluated. Results At T2, there was a reduction of headache frequency and disability. At T2, the EEG power significantly diminished as compared to T0 and T1 at occipital sites, and the topographical analysis confirmed a restoration of SSVEPs within normal values. The Oxyhemoglobin levels in occipital cortex, which were basically increased during visual stimulation in migraine patients, reverted to normal values at T2. Conclusions The present pilot study indicates that Galcanezumab could act on cortical targets located beyond the pain network, restoring the abnormal occipital reactivity. This effect could indicate the possible disease modifying properties of CGRP related monoclonal antibodies.

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Section: Open Accessmentioning

confidence: 99%

Central effects of galcanezumab in migraine: a pilot study on Steady State Visual Evoked Potentials and occipital hemodynamic response in migraine patients

et al. 2022

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“…The rational for targeting the motor cortex or the DLPFC was mainly taken over from trials in chronic pain disorders and depression [11]. Given that responsivity indexed by neurophysiological tests is mainly abnormal in the visual cortex of CM patients and amenable to therapeutic interventions [16,17], one may question whether the motor cortex and DLPFC are the most appropriate targets [41].…”

Section: Discussionmentioning

confidence: 99%

Exploring the Therapeutic Potential of Quadripulse rTMS over the Visual Cortex: A Proof-of-Concept Study in Healthy Volunteers and Chronic Migraine Patients with Medication Overuse Headache

Viganò,

Sasso D’Elia,

Sava

et al. 2024

Biomedicines

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In chronic migraine with medication overuse (CM-MOH), sensitization of visual cortices is reflected by (i) increased amplitude of stimulus-evoked responses and (ii) habituation deficit during repetitive stimulation. Both abnormalities might be mitigated by inhibitory transcranial neurostimulation. Here, we tested an inhibitory quadripulse repetitive transcranial magnetic stimulation (rTMS-QPI) protocol to decrease durably visual cortex excitability in healthy subjects (HS) and explored its therapeutic potential in CM-MOH patients. Pattern-reversal visual evoked potentials (VEP) were used as biomarkers of effect and recorded before (T1), immediately after (T2), and 3 h after stimulation (T3). In HS, rTMS-QPI durably decreased the VEP 1st block amplitude (p < 0.05) and its habituation (p < 0.05). These changes were more pronounced for the P1N2 component that was modified already at T2 up to T3, while for N1P1 they were significant only at T3. An excitatory stimulation protocol (rTMS-QPE) tended to have an opposite effect, restricted to P1N2. In 12 CM-MOH patients, during a four-week treatment (2 sessions/week), rTMS-QPI significantly reduced monthly headache days (p < 0.01). In patients reversing from CM-MOH to episodic migraine (n = 6), VEP habituation significantly improved after treatment (p = 0.005). rTMS-QPI durably decreases visual cortex responsivity in healthy subjects. In a proof-of-concept study of CM-MOH patients, rTMS-QPI also has beneficial clinical and electrophysiological effects, but sham-controlled trials are needed.

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“…In particular, the VN showed an opposite pattern between the two groups of patients, possibly suggesting a different role in the pathogenesis of the two groups and certainly due to the inclusion of patients with incomplete matching of baseline data. Previous studies have suggested that the occipital lobe has the potential to serve as a target for the neuromodulatory treatment of migraine (e.g., transcranial magnetic stimulation) 44 . In addition, de Tommaso et al 45 compared the EEG power spectrum of patients with migraine before and after injection of calcitonin gene‐related peptide antibodies and found a decrease in the power spectrum of the occipital region 3 months after injection, suggesting that occipital EEG indicators may have the potential to predict the efficacy of calcitonin gene‐related peptide antibodies.…”

Section: Discussionmentioning

confidence: 99%

“…vious studies have suggested that the occipital lobe has the potential to serve as a target for the neuromodulatory treatment of migraine (e.g., transcranial magnetic stimulation). 44 In addition, de Tommaso et al 45…”

Section: F I G U R Ementioning

confidence: 99%

Resting‐state electroencephalography microstate dynamics altered in patients with migraine with and without aura—A pilot study

Lei,

Wei,

Wang

et al. 2023

Headache

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ObjectiveTo evaluate electroencephalography (EEG) microstate differences between patients with migraine with aura (MWA), patients with migraine without aura (MWoA), and healthy controls (HC).BackgroundPrevious research employing microstate analysis found unique microstate alterations in patients with MWoA; however, it is uncertain how microstates appear in patients with MWA.MethodsThis study was conducted at the Headache Clinic of the First Affiliated Hospital of Xi'an Jiaotong University. In total, 30 patients with MWA, 30 with MWoA, and 30 HC were enrolled in this cross‐sectional study. An EEG was recorded for all participants under resting state. The microstate parameters of four widely recognized microstate classes A–D were calculated and compared across the three groups.ResultsThe occurrence of microstate B (MsB) in the MWoA group was significantly higher than in the HC (p = 0.006, Cohen's d = 0.72) and MWA (p = 0.016, Cohen's d = 0.57) groups, while the contribution of MsB was significantly increased in the MWoA group compared to the HC group (p = 0.016, Cohen's d = 0.64). Microstate A (MsA) displayed a longer duration in the MWA group compared to the MWoA group (p = 0.007, Cohen's d = 0.69). Furthermore, the transition probability between MsB and microstate D was significantly increased in the MWoA group compared to the HC group (p = 0.009, Cohen's d = 0.68 for B to D; p = 0.007, Cohen's d = 0.71 for D to B). Finally, the occurrence and contribution of MsB were positively related to headache characteristics in the MWoA group but negatively in the MWA group, whereas the duration of MsA was positively related to the visual analog scale in the MWA group (all p < 0.05).ConclusionsPatients with MWA and MWoA have altered microstate dynamics, indicating that resting‐state brain network disorders may play a role in migraine pathogenesis. Microstate parameters may have the potential to aid clinical management, which needs to be investigated further.

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The visual system as target of non-invasive brain stimulation for migraine treatment: Current insights and future challenges

Cited by 5 publications

References 225 publications

Central effects of galcanezumab in migraine: a pilot study on Steady State Visual Evoked Potentials and occipital hemodynamic response in migraine patients

Central effects of galcanezumab in migraine: a pilot study on Steady State Visual Evoked Potentials and occipital hemodynamic response in migraine patients

Exploring the Therapeutic Potential of Quadripulse rTMS over the Visual Cortex: A Proof-of-Concept Study in Healthy Volunteers and Chronic Migraine Patients with Medication Overuse Headache

Resting‐state electroencephalography microstate dynamics altered in patients with migraine with and without aura—A pilot study

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