title: Noninvasive neurostimulation methods for migraine therapy: The available evidence.
abstract: Background Migraine is one of the most disabling neurological disorders. The current pharmacological armamentarium is not satisfying for a large proportion of patients because the responder rate does not exceed 50% on average and the most effective drugs often induce intolerable side effects. During recent years, noninvasive central and peripheral neuromodulation methods have been explored for migraine treatment. Overview A review of the available evidence suggests that noninvasive neuromodulation techniques could be beneficial for migraine patients. The transcranial stimulation methods allow modulating selectively cortical activity and can thus be curtailed to the patient's pathophysiological profile, while transcutaneous stimulation of pericranial nerves likely modulates central pain control centers. Occipital single-pulse transcranial magnetic stimulation and transcutaneous supraorbital stimulation have the strongest evidence respectively for acute and preventive treatment. Transcranial direct current stimulation and repetitive magnetic stimulation are promising in pilot studies, but large sham-controlled trials are not yet available. Conclusions The noninvasive neurostimulation methods are promising for migraine treatment and devoid of serious adverse effects allowing their combination with drug therapies. Their application in clinical practice will depend on the industry's capacity to develop portable and user-friendly devices, and on the scientists' capacity to prove their efficacy in randomized sham-controlled trials.
authors.affiliation: 1 Liège University, Headache Research Unit, University Department of Neurology, Belgium.
authors.forename: Jean
authors.initials: J
authors.lastname: Schoenen
authors.affiliation: 2 Headache Center and Unit of Neurology and Neurophysiopathology, University of Palermo, Italy.
authors.forename: Baschi
authors.initials: B
authors.lastname: Roberta
authors.affiliation: 1 Liège University, Headache Research Unit, University Department of Neurology, Belgium.
authors.forename: Delphine
authors.initials: D
authors.lastname: Magis
authors.affiliation: 3 G.B. Bietti Foundation IRCCS, Department of Neurophysiology of Vision and Neurophthalmology, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Coppola
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D008881:Migraine Disorders / Q000175:diagnosis* / Q000628:therapy*; D065908:Transcranial Direct Current Stimulation / Q000379:methods*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: Transcranial magnetic stimulation; transcranial direct current stimulation; transcutaneous supraorbital stimulation; vagus nerve stimulation