Chronic Migraine Preventive Treatment by Prefrontal-Occipital Transcranial Direct Current Stimulation (tDCS): A Proof-of-Concept Study on the Effect of Psychiatric Comorbidities.

Simone Badini,Vittorio Di Piero,Massimiliano Toscano,Giulio Mastria,Cristina Pirillo,Marta Altieri,Alessandra Corrado,Roberto Delle Chiaie,Barbara Petolicchio,Valentina Mancini,Alessandro Viganò

doi:10.3389/fneur.2021.654900

Abstract

Chronic migraine (CM) is often complicated by medication overuse headache (MOH) and psychiatric comorbidities that may influence the clinical outcome. This study aimed to investigate the relationship between psychiatric comorbidities and the effect of transcranial direct current stimulation (tDCS) in patients with CM with or without MOH. We recruited 16 consecutive CM patients who had an unsatisfactory response to at least three pharmacological preventive therapies. They were treated with anodal right-prefrontal and cathodal occipital tDCS (intensity: 2 mA, time: 20 min) three times per week for 4 weeks. All patients underwent a psychopathological assessment before and after treatment, and five of them were diagnosed with bipolar disorder (BD). After treatment, all the patients showed a significant decrease of severe and overall headache days per month. Despite having a higher migraine burden at baseline, patients with CM and BD showed a significantly greater reduction of severe headaches and psychiatric symptoms. Overall, tDCS seems to be effective in the treatment of CM patients with a poor response to different classes of pharmacological therapies, whereas BD status positively influences the response of migraineurs to tDCS.

Highlights

Chronic migraine (CM) is a severe condition characterized by more than 15 headache days per month, 8 of which presenting migraine features, lasting at least 3 months [1]
Regarding the potential efficacy of the transcranial direct current stimulation (tDCS) treatment, we evaluated the reduction of the migraine burden and medication overuse
Allodynia had no impact on migraine at baseline (Spearman ρ = 0.36, p = 0.166) and the clinical response to tDCS (Spearman ρ = 0.32, p = 0.22). In this proof-of-concept study, we demonstrated the feasibility and safety of a tDCS protocol based on the combination of cathodal stimulation over the visual cortex and anodal stimulation of the right dorsolateral prefrontal cortex (rDLPFC) for migraine treatment

Summary

Introduction

Chronic migraine (CM) is a severe condition characterized by more than 15 headache days per month, 8 of which presenting migraine features, lasting at least 3 months [1]. It represents the most common type of headache referring to specialized headache centers. Treatment adherence is quite poor and heavily affected by side effects [3, 4]. There is an increasing interest in therapeutic alternatives with fewer side effects, including non-pharmaceutical treatments. The poor outcome of preventive treatments is mostly attributable to CM multifactorial pathophysiology, in which electrophysiological alterations, psychiatric comorbidities, and environmental factors concur to reverberate pain [2]

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