title: Prophylactic treatment in menstrual migraine: A proof-of-concept study.
abstract: The present study aimed to investigate the efficacy of repetitive cathodal direct current stimulation (rctDCS) over the visual cortex as a prophylactic treatment in patients with menstrual migraine. 20 female patients were recruited in this double-blind, placebo-controlled study and were assigned to receive either cathodal or sham stimulation. Over 3 menstrual cycles, tDCS with 2mA intensity and 20 min duration was applied to the visual cortex of the patients, in 5 consecutive sessions 1-5 days prior to the first day of their menstruation. The primary endpoint of the study was the frequency of the migraine attacks at the end of the treatment period, however, additional parameters, such as the number of migraine related days and the intensity of pain were also recorded 3 months before, during and 3 months post-treatment. Visual cortex excitability was determined by measuring the phosphene thresholds (PTs) using single pulse transcranial magnetic stimulation (TMS) over the visual cortex. Sixteen patients completed the study. A significant decrease in the number of migraine attacks (p=0.04) was found in the cathodal group compared to baseline but not compared to sham (p=0.053). In parallel the PTs increased significantly in this group, compared to the sham group (p<0.05). Our results indicate that prophylactic treatment with rctDCS over the visual cortex might be able to decrease the number of attacks in patients with menstrual migraine, probably by modifying cortical excitability.
authors.affiliation: Department of Clinical Neurophysiology, University Medical Center, Georg-August University, 37075 Göttingen, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Wickmann
authors.affiliation: Department of Clinical Neurophysiology, University Medical Center, Georg-August University, 37075 Göttingen, Germany.
authors.forename: Caspar
authors.initials: C
authors.lastname: Stephani
authors.affiliation: Department of Clinical Neurophysiology, University Medical Center, Georg-August University, 37075 Göttingen, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Czesnik
authors.affiliation: Department of Clinical Neurophysiology, University Medical Center, Georg-August University, 37075 Göttingen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Klinker
authors.affiliation: Department of Clinical Neurophysiology, University Medical Center, Georg-August University, 37075 Göttingen, Germany.
authors.forename: Charles
authors.initials: C
authors.lastname: Timäus
authors.affiliation: Department of Clinical Neurophysiology, University Medical Center, Georg-August University, 37075 Göttingen, Germany.
authors.forename: Leila
authors.initials: L
authors.lastname: Chaieb
authors.affiliation: Department of Clinical Neurophysiology, University Medical Center, Georg-August University, 37075 Göttingen, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: Paulus
authors.affiliation: Department of Clinical Neurophysiology, University Medical Center, Georg-August University, 37075 Göttingen, Germany. Electronic address: AAntal@gwdg.de.
authors.forename: Andrea
authors.initials: A
authors.lastname: Antal
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008598:Menstruation / Q000502:physiology*; D008881:Migraine Disorders / Q000175:diagnosis* / Q000628:therapy*; D065129:Pre-Exposure Prophylaxis; D065908:Transcranial Direct Current Stimulation / Q000379:methods*; D016896:Treatment Outcome; D014793:Visual Cortex / Q000502:physiology*; D055815:Young Adult
keywords: Cathodal; Migraine; Prophylaxis; Repetitive transcranial stimulation; Visual cortex; tDCS