Outcomes of Transcutaneous Nerve Stimulation for Migraine Headaches: a Systematic Review and Meta-analysis

Overview

Journal J Neurol

Specialty Neurology

Date 2022 Mar 17

PMID 35296960

Authors

Adam G Evans

Abigail N Horrar

Maryo M Ibrahim

Brady L Burns

Christopher L Kalmar

Patrick E Assi

Krista N Brooks-Horrar

Tigran Kesayan

Salam Al Kassis

Affiliations

Soon will be listed here.

Abstract

Background: Implanted and transcutaneous nerve stimulators have shown promise as novel non-pharmacologic treatment for episodic and chronic migraines. The purpose of this study was to summarize the reported efficacy of transcutaneous single nerve stimulators in management of migraine frequency and severity.

Methods: A systematic review of five databases identified studies treating migraines with transcutaneous stimulation of a single nerve. Random effects model meta-analyses were conducted to establish the effect of preventive transcutaneous nerve stimulation on headache days per month and 0-10 numeric rating scale pain severity of headaches for both individuals with episodic and chronic migraines.

Results: Fourteen studies, which treated 995 patients, met inclusion criteria, including 7 randomized controlled trials and 7 uncontrolled clinical trials. Transcutaneous nerve stimulators reduced headache frequency in episodic migraines (2.81 fewer headache days per month, 95% CI 2.18-3.43, I = 21%) and chronic migraines (2.97 fewer headache days per month, 95% CI 1.66-4.28, I = 0%). Transcutaneous nerve stimulators reduced headache severity in episodic headaches (2.23 fewer pain scale points, 95% CI 1.64-2.81, I = 88%).

Conclusions: Preventive use of transcutaneous nerve stimulators provided clinically significant reductions in headache frequency in individuals with chronic or episodic migraines. Individuals with episodic migraines also experienced a reduction in headache pain severity following preventive transcutaneous nerve stimulation.

Citing Articles

Preoperative visualization of the greater occipital nerve with magnetic resonance imaging in candidates for occipital nerve decompression for headaches.

Saad M, Manzanera Esteve I, Evans A, Karagoz H, Kesayan T, Brooks-Horrar K Sci Rep. 2024; 14(1):15248.

PMID: 38956162 PMC: 11219832. DOI: 10.1038/s41598-024-65334-4.

Efficacy of cranial electrotherapy stimulation in patients with burning mouth syndrome: a randomized, controlled, double-blind pilot study.

Palmer A, Hamann T, Liese J, Muller B, Kropp P, Jurgens T Front Neurol. 2024; 15:1343093.

PMID: 38419716 PMC: 10900232. DOI: 10.3389/fneur.2024.1343093.

Emergency Department Alternatives to Opioids: Adapting and Implementing Proven Therapies in Practice.

Floyd S, NcGarby S, Romero S, Garrison S, Walker K, Hendry W Int J Environ Res Public Health. 2023; 20(2).

PMID: 36673962 PMC: 9858618. DOI: 10.3390/ijerph20021206.

References

Steiner T, Stovner L, Jensen R, Uluduz D, Katsarava Z . Migraine remains second among the world's causes of disability, and first among young women: findings from GBD2019. J Headache Pain. 2020; 21(1):137. PMC: 7708887. DOI: 10.1186/s10194-020-01208-0. View

Burch R, Rizzoli P, Loder E . The Prevalence and Impact of Migraine and Severe Headache in the United States: Figures and Trends From Government Health Studies. Headache. 2018; 58(4):496-505. DOI: 10.1111/head.13281. View

Stewart W, Ricci J, Chee E, Morganstein D, Lipton R . Lost productive time and cost due to common pain conditions in the US workforce. JAMA. 2003; 290(18):2443-54. DOI: 10.1001/jama.290.18.2443. View

Robbins M . Diagnosis and Management of Headache: A Review. JAMA. 2021; 325(18):1874-1885. DOI: 10.1001/jama.2021.1640. View

Filipovic B, Matak I, Lackovic Z . Dural neurogenic inflammation induced by neuropathic pain is specific to cranial region. J Neural Transm (Vienna). 2013; 121(5):555-63. DOI: 10.1007/s00702-013-1144-4. View

Li C, White T, Shah K, Chaung W, Powell K, Wang P . Percutaneous Trigeminal Nerve Stimulation Induces Cerebral Vasodilation in a Dose-Dependent Manner. Neurosurgery. 2021; 88(6):E529-E536. PMC: 8117435. DOI: 10.1093/neuros/nyab053. View

Kosaras B, Jakubowski M, Kainz V, Burstein R . Sensory innervation of the calvarial bones of the mouse. J Comp Neurol. 2009; 515(3):331-48. PMC: 2710390. DOI: 10.1002/cne.22049. View

Schueler M, Messlinger K, Dux M, Neuhuber W, De R . Extracranial projections of meningeal afferents and their impact on meningeal nociception and headache. Pain. 2013; 154(9):1622-1631. DOI: 10.1016/j.pain.2013.04.040. View

Goadsby P . Pathophysiology of migraine. Ann Indian Acad Neurol. 2012; 15(Suppl 1):S15-22. PMC: 3444225. DOI: 10.4103/0972-2327.99993. View

10.

Tang Y, Kang J, Zhang Y, Zhang X . Influence of greater occipital nerve block on pain severity in migraine patients: A systematic review and meta-analysis. Am J Emerg Med. 2017; 35(11):1750-1754. DOI: 10.1016/j.ajem.2017.08.027. View

11.

Seal R . Illuminating the Gap: Neuronal Cross-Talk within Sensory Ganglia and Persistent Pain. Neuron. 2016; 91(5):950-951. DOI: 10.1016/j.neuron.2016.08.030. View

12.

Piovesan E, Kowacs P, Tatsui C, Lange M, Ribas L, Werneck L . Referred pain after painful stimulation of the greater occipital nerve in humans: evidence of convergence of cervical afferences on trigeminal nuclei. Cephalalgia. 2001; 21(2):107-9. DOI: 10.1046/j.1468-2982.2001.00166.x. View

13.

Busch V, Jakob W, Juergens T, Schulte-Mattler W, Kaube H, May A . Functional connectivity between trigeminal and occipital nerves revealed by occipital nerve blockade and nociceptive blink reflexes. Cephalalgia. 2006; 26(1):50-5. DOI: 10.1111/j.1468-2982.2005.00992.x. View

14.

Chua N, van Suijlekom H, Vissers K, Arendt-Nielsen L, Wilder-Smith O . Differences in sensory processing between chronic cervical zygapophysial joint pain patients with and without cervicogenic headache. Cephalalgia. 2011; 31(8):953-63. DOI: 10.1177/0333102411408358. View

15.

Dodick D, Silberstein S, Reed K, Deer T, Slavin K, Huh B . Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: long-term results from a randomized, multicenter, double-blinded, controlled study. Cephalalgia. 2014; 35(4):344-58. DOI: 10.1177/0333102414543331. View

16.

Silberstein S, Dodick D, Saper J, Huh B, Slavin K, Sharan A . Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: results from a randomized, multicenter, double-blinded, controlled study. Cephalalgia. 2012; 32(16):1165-79. DOI: 10.1177/0333102412462642. View

17.

Bono F, Salvino D, Mazza M, Curcio M, Trimboli M, Vescio B . The influence of ictal cutaneous allodynia on the response to occipital transcutaneous electrical stimulation in chronic migraine and chronic tension-type headache: a randomized, sham-controlled study. Cephalalgia. 2014; 35(5):389-98. DOI: 10.1177/0333102414544909. View

18.

Chou D, Yugrakh M, Winegarner D, Rowe V, Kuruvilla D, Schoenen J . Acute migraine therapy with external trigeminal neurostimulation (ACME): A randomized controlled trial. Cephalalgia. 2018; 39(1):3-14. PMC: 6348457. DOI: 10.1177/0333102418811573. View

19.

Diener H, Goadsby P, Ashina M, Al-Karagholi M, Sinclair A, Mitsikostas D . Non-invasive vagus nerve stimulation (nVNS) for the preventive treatment of episodic migraine: The multicentre, double-blind, randomised, sham-controlled PREMIUM trial. Cephalalgia. 2019; 39(12):1475-1487. PMC: 6791025. DOI: 10.1177/0333102419876920. View

20.

Hokenek N, Erdogan M, Dalkilinc Hokenek U, Algin A, Tekyol D, Seyhan A . Treatment of migraine attacks by transcutaneous electrical nerve stimulation in emergency department: A randomize controlled trial. Am J Emerg Med. 2020; 39:80-85. DOI: 10.1016/j.ajem.2020.01.024. View