Therapeutisches Potenzial der transkraniellen Wechselstromstimulation über dem visuellen Kortex in der häuslichen Behandlung akuter Migräne

Abstract

Around 5,7 million people in Germany suffer from migraine. This disorder leads to strong restrictions in the professional and social life of the affected people. As the standard drug therapy results in several adverse effects and has restricted efficacy, there is a need for new therapeutic options. In this doctoral thesis the efficacy of low intensity, high frequency transcranial alternating current stimulation (tACS) over the visual cortex has been investigated as an acute domestic treatment option for patients with migraine. There is evidence that migraine is accompanied by altered neuronal activity, often considered as a neuronal hyperexcitability. The present study was based on the hypothesis that the applied form of tACS could adjust neuronal activity in migraineurs and hence might be able to stop the migraine attack and/or reduce migraine symptoms. 40 patients were included in this double-blind, placebo-controlled study and received either active or sham stimulation. After an instruction in the clinic the patients received a preprogrammed stimulator that should be used for the treatment of a maximum of five migraine attacks during six weeks at home. In the active stimulation condition tACS of 0,4 mA and 140 Hz was applied for 15 minutes over the visual cortex. During the sham stimulation the stimulator applied current for a duration of 30 seconds and then turned off automatically. The primary endpoint of the study was the number of terminated attacks two hours after the stimulation. Secondary endpoints were the perceived pain intensity in the first 24 hours after stimulation and the need of additional drug intake. The 25 patients that completed the study (16 in the acute and nine in the sham group) treated altogether 102 migraine attacks. The number of terminated migraine attacks without additional drug intake within two hours after stimulation was significantly higher in the active (21,5 %) than in the sham group (0 %). Likewise the observed pain after acute stimulation was significantly less for 1-4 hours after the stimulation in the active group compared to the values in the sham group. Nevertheless the patients in the active group showed a greater need of additional drug intake. The results indicate that acute treatment with tACS over the visual cortex might be able to terminate migraine attacks in patients, probably by modifying cortical excitability or oscillatory activity. However, the high drop-out rate suggests that this method might not be ready for home-application.