Long‐Term Effects of Self‐Administered Transcranial Direct Current Stimulation in Episodic Migraine Prevention: Results of a Randomized Controlled Trial
Background Migraine is a multifactorial neurovascular disorder, which affects about 12% of the general population. In episodic migraine, the visual cortex revealed abnormal processing, most likely due to decreased preactivation level. Transcranial direct current stimulation (tDCS) is able to modify...
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| Published in: | Neuromodulation (Malden, Mass.) Vol. 24; no. 5; pp. 890 - 898 |
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| Main Authors: | , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Hoboken, USA
John Wiley & Sons, Inc
01.07.2021
Elsevier Limited John Wiley and Sons Inc |
| Subjects: | |
| ISSN: | 1094-7159, 1525-1403, 1525-1403 |
| Online Access: | Get full text |
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| Summary: | Background
Migraine is a multifactorial neurovascular disorder, which affects about 12% of the general population. In episodic migraine, the visual cortex revealed abnormal processing, most likely due to decreased preactivation level. Transcranial direct current stimulation (tDCS) is able to modify cortical excitability and might result in an alleviation of migraine occurrence if used repetitively.
Objective
To test the hypothesis that self‐administered anodal tDCS over the visual cortex significantly decreases the number of monthly migraine days in episodic migraine.
Materials and Methods
The study was single‐blind, randomized, and sham‐controlled. Inclusion criteria were age 18–80 years and an ICHD‐3 diagnosis of episodic migraine. Exclusion criteria were pregnancy, presence of a neurodegenerative disorder, a contraindication against MRI examinations, and less than two migraine days during the 28‐day baseline period. Patients in whom the baseline period suggested chronic migraine were excluded. After baseline, participants applied daily either verum (anodal‐1 mA to 20 min) or sham tDCS (anodal‐1 mA to 30 sec) at Oz (reference Cz electrode) for 28 days. Headache diaries were used to record the number of migraine days at baseline, during the stimulation period, and during four subsequent 28‐day periods.
Results
Twenty‐eight patients were included; two were excluded after the baseline period because less than two migraine days occurred; three were excluded because their headache diaries suggested the diagnosis of chronic migraine. Twenty‐three datasets were taken for further analysis. Compared to sham tDCS (n = 12), verum tDCS (n = 11) resulted in a lower number of migraine days (p = 0.010) across all follow‐up periods. We found no significant change in total headache days (p = 0.165), anxiety (p = 0.884), or depression scores (p = 0.535). No serious adverse events occurred; minor side effects were similar in both groups.
Conclusions
This study provides Class II evidence that self‐administered anodal tDCS over the visual cortex in episodic migraine results in a significantly lower number of monthly migraine days. However, it has neither an immediate nor a long‐term effect. |
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| Bibliography: | Source(s) of financial support: Heiko Pohl was funded by the Werner Dessauer Stiftung. Christian C. Ruff received support from the SNSF (grant no. 100019L_173248) and from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation program (grant agreement No 725355, BRAINCODES). For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to Conflict of Interest http://www.wiley.com/WileyCDA/Section/id-301854.html Heiko Pohl received speaker fees from TEVA Pharmaceuticals and honoraria from Eli Lilly. Jean Schoenen is Investigator/advisor for Amgen, Allergan, Eli‐Lilly, Novartis, Teva, Dr. Schoenen has received speaker fees from Novartis and Teva and personal fees from Cefaly Technology. Hans H. Jung was advisor for Alexion, Alnylam, CSL‐Behring, Ipsen, Mitsubishi, and Sanofi‐Aventis, and received speaker fees from Alexion, Alnylam, and Sanofi‐Aventis. He also reports grants from University Hospital Zurich, during the conduct of the study. Franz Riederer has received speaker honoraria from Burgerstein Foundation, Lilly, Teva, and Novartis. Dr. Sandor reports personal fees from Novartis, personal fees from Teva, personal fees from Lilly, personal fees from Almirall, outside the submitted work. J. Aschmann, Kathrin Brenner, Dr. Gantenbein, Dr. Widmer, Dr. Luechinger, Dr. Michels, Dr. Moisa, Dr. Petersen, and Dr. Ruff have no conflicts of interest to disclose. ObjectType-Article-2 SourceType-Scholarly Journals-1 content type line 14 ObjectType-Feature-3 ObjectType-Evidence Based Healthcare-1 ObjectType-Article-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 scopus-id:2-s2.0-85092713729 |
| ISSN: | 1094-7159 1525-1403 1525-1403 |
| DOI: | 10.1111/ner.13292 |