Abstract
Summary: Three consecutive daily sessions of cathodal transcranial direct current stimulation (tDCS) was sufficient to show a significant decrease in headache duration and intensity as well as tablets consumption, in patients suffering from episodic migraine. Background: Migraine prophylaxis is recommended in patients with frequent and/or intense headaches, but poor tolerability and lack of efficacy of preventive drugs are common in clinical practice. Hence, new prophylactic strategies are needed. Objective: The aim of this study was to evaluate the efficacy of tDCS in terms of migraine prophylaxis. Methods: This was a double blind and sham-controlled trial. Forty-two migraine patients were randomly assigned in a crossover design to receive three consecutive daily sessions of both sham and cathodal tDCS stimulation (2.0 mA, 20 min) over the occipital cortex of the dominant side of the migraine pain (O1/O2). Migraine duration and intensity, number of analgesic tablets, and number of headache-free days (where no headache abortive medications are taken) were recorded one week before and two weeks after treatment. A washout period of one week was allowed before crossing to the other treatment arm. Results: Relative to sham, cathodal stimulation was associated with a significant reduction in the number of headache days, tablets consumption, and pain intensity; and a significant increase in the number of headache-free days. These beneficial effects were sustained over two weeks. No serious side effects were observed, and the procedure was well tolerated. Conclusion: Based on these findings, cathodal tDCS applied to the occipital cortex seems to be an effective and well tolerated alternative to pharmacotherapy in patients with episodic migraine.
Highlights
Migraine is a complex neurological condition characterized by recurrent episodes of throbbing headaches of at least moderate intensity [1]
Inclusion criteria included age between 18 and 60 years, history of episodic migraine with or without aura according to the International Headache Society (HIS) 3rd edition criteria, and at least 4 migraine days per month
Patients who were on migraine preventive medication were allowed to participate in the study if no changes in dosage had been implemented in the previous 3 months and none were anticipated in the following 2 months
Summary
Migraine is a complex neurological condition characterized by recurrent episodes of throbbing headaches of at least moderate intensity [1]. With an estimated prevalence of 13–18%, it is a leading cause of disease-related disability worldwide, surpassing that of stroke, epilepsy, and head trauma [2]. Management of migraine is based on pharmacological agents and avoidance of known migraine triggers. Migraine prevention is based on a number of drug classes including beta-blockers, antidepressants, and anti-epileptics, among others [3]. Epidemiological data have shown that only a subset of patients with frequent migraine attacks are offered prophylactic drugs [4], half of whom eventually discontinue treatment because of lack of efficacy or intolerable side effects [3]. There is a great unmet need for novel treatments that are both effective and tolerable
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