Author: Oliver Clark1, Areej Mahjoub2, Nily Osman3, Ann-Marie Surmava4, Saber Jan5, Ana Marissa Lagman-Bartolome6,7
Affiliation: <sup>1</sup> Department of Internal Medicine, Pennsylvania Hospital, 800 Spruce St, Philadelphia, PA, 19107, USA.
<sup>2</sup> Division of Pediatric Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada.
<sup>3</sup> Women's College Hospital, University of Toronto, 76 Grenville St, Toronto, ON, M5S1B2, Canada.
<sup>4</sup> University of Toronto, 27 King's College Circle, Toronto, ON, M5S 3K1, Canada.
<sup>5</sup> Department of Pediatrics, Taibah University, Janadah Bin Umayyah Road, Tayba, Medina, Saudi Arabia.
<sup>6</sup> Division of Pediatric Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada. marissa.lagman@wchospital.ca.
<sup>7</sup> Women's College Hospital, University of Toronto, 76 Grenville St, Toronto, ON, M5S1B2, Canada. marissa.lagman@wchospital.ca.
Conference/Journal: Neurol Sci
Date published: 2021 Oct 26
Other:
Special Notes: doi: 10.1007/s10072-021-05664-7. , Word Count: 256
Objective:
A systematic review and meta-analysis was performed to determine the efficacy of non-invasive neuromodulation modalities for the treatment of acute migraine.
Background:
Although pharmacological treatments are the gold standard for the management of acute migraine, some patients may require non-pharmacological treatment options. Non-invasive neuromodulation may provide an alternative, and techniques include transcranial magnetic stimulation (TMS), non-invasive vagal nerve stimulation (nVNS), non-painful remote electrical stimulation (NRES), and external trigeminal nerve stimulation (e-TNS).
Methods:
This systematic review and meta-analysis was performed following PRISMA guidelines. We searched PUBMED, EMBASE, ClinicalTrials.gov, Cochrane Center Register of Controlled Trials, and LILACS databases. We included randomized controlled clinical trials studying patients with migraine treated with any form of non-invasive neuromodulation. Primary outcome was pain freedom within 2 h post-treatment. Secondary outcomes were pain relief within 2-h post-treatment and sustained pain freedom and sustained pain relief 48 h post-treatment.
Results:
Pooled analysis demonstrated a significant effect of non-invasive neuromodulation on pain-free rates within 2 h (RR, 1.66; 95% CI, 1.35 to 2.05; P < 0.00001) and pain relief rates within 2 h (RR, 1.52; 95% CI, 1.13 to 2.05; P = 0.005) post-treatment. Non-invasive neuromodulation had no significant effect on sustained pain freedom at 48 h (RR, 1.56; 95% CI, 0.68 to 3.59; P = 0.29) or sustained pain relief at 48 h (RR, 1.47; 95% CI, 0.57 to 3.77; P = 0.43) after administration.
Conclusion:
Neuromodulation has demonstrated some efficacy in acute migraine management and may be considered in the treatment paradigm of acute migraine in patients with contraindications to pharmacological therapies.
Keywords: External trigeminal nerve stimulation (e-TNS); Migraine; Neuromodulation; Non-invasive vagal nerve stimulation (nVNS); Non-painful remote electrical stimulation (NRES); Transcranial magnetic stimulation (TMS).
PMID: 34698941 DOI: 10.1007/s10072-021-05664-7