Update of Neuromodulation in Chronic Migraine

Yuan, Hsiangkuo; Chuang, Tzu-Ying

doi:10.1007/s11916-021-00988-7

Cited by 11 publications

(16 citation statements)

References 54 publications

(72 reference statements)

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“…Numerous studies have demonstrated that tcVNS reduces the frequency and intensity of migraine attacks and cluster headaches ( 23 – 27 ). In fact, the United States Food and Drug Administration recently cleared tcVNS for acute and preventive treatment of pain associated with most forms of primary headache ( 28 ). Recent work has also explored tcVNS effects on noxious stimuli applied peripherally (e.g., leg) ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

Pain is reduced by transcutaneous cervical vagus nerve stimulation and correlated with cardiorespiratory variability measures in the context of opioid withdrawal

Gazi

Harrison²,

Lambert³

et al. 2022

Front. Pain Res.

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Over 100,000 individuals in the United States lost their lives secondary to drug overdose in 2021, with opioid use disorder (OUD) being a leading cause. Pain is an important component of opioid withdrawal, which can complicate recovery from OUD. This study's objectives were to assess the effects of transcutaneous cervical vagus nerve stimulation (tcVNS), a technique shown to reduce sympathetic arousal in other populations, on pain during acute opioid withdrawal and to study pain's relationships with objective cardiorespiratory markers. Twenty patients with OUD underwent opioid withdrawal while participating in a two-hour protocol. The protocol involved opioid cues to induce opioid craving and neutral conditions for control purposes. Adhering to a double-blind design, patients were randomly assigned to receive active tcVNS (n = 9) or sham stimulation (n = 11) throughout the protocol. At the beginning and end of the protocol, patients' pain levels were assessed using the numerical rating scale (0–10 scale) for pain (NRS Pain). During the protocol, electrocardiogram and respiratory effort signals were measured, from which heart rate variability (HRV) and respiration pattern variability (RPV) were extracted. Pre- to post- changes (denoted with a Δ) were computed for all measures. Δ NRS Pain scores were lower (P = 0.045) for the active group (mean ± standard deviation: −0.8 ± 2.4) compared to the sham group (0.9 ± 1.0). A positive correlation existed between Δ NRS pain scores and Δ RPV (Spearman's ρ = 0.46; P = 0.04). Following adjustment for device group, a negative correlation existed between Δ HRV and Δ NRS Pain (Spearman's ρ = −0.43; P = 0.04). This randomized, double-blind, sham-controlled pilot study provides the first evidence of tcVNS-induced reductions in pain in patients with OUD experiencing opioid withdrawal. This study also provides the first quantitative evidence of an association between breathing irregularity and pain. The correlations between changes in pain and changes in objective physiological markers add validity to the data. Given the clinical importance of reducing pain non-pharmacologically, the findings support the need for further investigation of tcVNS and wearable cardiorespiratory sensing for pain monitoring and management in patients with OUD.

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Section: Discussionmentioning

confidence: 99%

Pain is reduced by transcutaneous cervical vagus nerve stimulation and correlated with cardiorespiratory variability measures in the context of opioid withdrawal

Gazi

Harrison²,

Lambert³

et al. 2022

Front. Pain Res.

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“…The dose for treatment of acute migraine attack comprises three consecutive pulses that can be given at the onset of an attack, followed by two pulses at an interval of 15 minutes, if required. The dose for prevention consists of four pulses that could be given twice daily [ 27 ].…”

Section: Reviewmentioning

confidence: 99%

Migraine and Neuromodulation: A Literature Review

Tiwari¹,

Agrawal²

2022

Cureus

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Migraine is not only known to be one of the most common causes of a headache around the globe but is also the leading neurologic cause of disability worldwide. Migraine has significant social and economic effects. It not only hampers patients' quality of life but also hampers work, public conduct, and family life. Migraine is one of the leading causes of morbidity in the world, so effective management is critical. Currently, medical management is the mainstay remedial approach for migraine, but with time, non-pharmacological approaches, especially neuromodulation, are gaining popularity with a shred of solid backing evidence. Neuromodulation is the process in which specific devices are used to excite the central nervous system or peripheral nervous system with electric or magnetic, or any other form of energy to regulate the abnormal behavior of neural pathways that have occurred due to the disease process. Neuromodulation devices as approved by Food and Drug Administration include non-invasive Vagus nerve stimulators, single-pulse transcranial magnetic stimulators, and transcutaneous supraorbital neurostimulators. The purpose of this study is to summarize the information about the advances relating to neuromodulation concerning managing and preventing migraine. This Narrative review article is prepared after analyzing various research papers and publications on PubMed and Google Scholar. This article holds brief information on understanding neuromodulation, its mechanism, its implication in managing migraine, and its different modalities with their mechanism of action and contraindications. These neuromodulation techniques can certainly be used to deal with acute migraine attacks and inhibit their progression to chronic illness. Research is required on the application of neuromodulation in the early diagnosis of migraine, which is what we still lack as a whole medical fraternity.

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“…[1][2][3][4][5] Its occurrence is associated with the neuropeptide-mediated pain pathways within the trigeminovascular system. [6][7][8] As the serotonin 5-HT 1B/1D receptor agonists, triptans are widely used antimigraine therapies, but may result in vasoconstriction by the activation of 5-HT 1B receptors and increase the risk of cardiovascular adverse events. 9,10 Triptans are often contraindicated due to cardiovascular diseases and other vascular disorders.…”

mentioning

confidence: 99%

Exploration of Lasmiditan 200 mg Versus 100 mg for the Treatment of Migraine: A Meta-analysis Based on Aggregate Data

Wang,

Feng

2024

Clin Neuropharm

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Objectives Lasmiditan holds important potential in treating migraine, but its ideal dose remains elusive. This meta-analysis is conducted based on aggregate data and aims to compare the efficacy of lasmiditan 200 mg versus 100 mg for acute treatment of migraine attack. Methods PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases were systematically searched, and we included the randomized controlled trials comparing the efficacy of lasmiditan 200 mg versus 100 mg for migraine patients. This meta-analysis was conducted using the random-effect model or fixed-effect model based on the heterogeneity. The primary outcome was pain free at 2 hours. Secondary outcomes included pain relief at 2 hours, pain free at 24 hours, most bothersome symptom free at 2 hours, and adverse events. Results Seven randomized controlled trials and 6515 patients were included in this meta-analysis. Compared with lasmiditan 100 mg for migraine patients, lasmiditan 200 mg was able to significantly improve pain free at 2 hours (odd ratio [OR], 1.28; 95% confidence interval [CI], 1.14–1.44; P < 0.0001) and pain free at 24 hours (OR, 1.35; 95% CI, 1.14–1.60; P = 0.0005), but showed no effect on pain relief at 2 hours (OR, 1.00; 95% CI, 0.90–1.12; P = 0.98) or most bothersome symptom free at 2 hours (OR, 0.93; 95% CI, 0.83–1.03; P = 0.17). Lasmiditan 200 mg was associated with the increase in adverse events compared with lasmiditan 100 mg (OR, 1.28; 95% CI, 1.15–1.43; P < 0.0001). Conclusions Lasmiditan 200 mg is more effective to improve pain free at 2 hours and 24 hours than lasmiditan 100 mg for the acute treatment of migraine patients.

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Update of Neuromodulation in Chronic Migraine

Cited by 11 publications

References 54 publications

Pain is reduced by transcutaneous cervical vagus nerve stimulation and correlated with cardiorespiratory variability measures in the context of opioid withdrawal

Pain is reduced by transcutaneous cervical vagus nerve stimulation and correlated with cardiorespiratory variability measures in the context of opioid withdrawal

Migraine and Neuromodulation: A Literature Review

Exploration of Lasmiditan 200 mg Versus 100 mg for the Treatment of Migraine: A Meta-analysis Based on Aggregate Data

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