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Effects of Non-invasive Brain Stimulation on Headache Intensity and Frequency of Headache Attacks in Patients With Migraine: A Systematic Review and Meta-Analysis.
Headache. 2019 10; 59(9):1436-1447.H

Abstract

BACKGROUND

Non-invasive brain stimulation (NIBS) techniques such as repetitive transcranial magnetic stimulation (rTMS), as well as transcranial direct current stimulation (tDCS) electrically stimulate the brain and modify brain activity to suppress pain. This method is emerging as a potential clinical intervention against migraine.

OBJECTIVE

To quantitatively review the efficacy of rTMS and tDCS in randomized controlled trials (RCTs) in modifying headache intensity and frequency of headache attacks in patients suffering from migraine.

METHODS

We searched 5 databases: PubMed, EMBASE, Web of Science, Cochrane Library, and Scopus for articles from January 2000 to September 2018. Any RCT regarding the efficacy on rTMS and tDCS on patients with migraine, was considered to be included. A random effects meta-analysis was performed to pool effect sizes of outcomes related to headache intensity or frequency of headache attacks. The methodological quality of the included RCTs was assessed using the Physiotherapy Evidence Database scale.

RESULTS

Nine RCTs with 276 participants in total (experimental group [EG] = 149; control group [CG] = 127) were included in this review. Five included articles used rTMS (EG = 81; CG = 80), and 4 used tDCS (EG = 68; CG = 47). Meta-analysis of excitatory primary motor cortex (M1) stimulation showed significant effects on reducing headache intensity in patients with migraine (Hedges' g = -0.94; 95% CI, -1.28 to -0.59; P < .001, I2 = 18.39%) with a large effect size. Meta-analysis of excitatory M1 stimulation showed significant effects on reducing frequency of headache attacks in patients with migraine, with a large effect size (Hedges' g = -0.88; 95% CI, -1.38 to -0.38; P = .001, I2 = 57.15%). Excitatory dorsolateral prefrontal cortex stimulation showed a significant effect on the headache intensity in patients with migraine (Hedges' g = -1.14; 95% CI, -2.21 to -0.07; P = .04, I2 = 61.86%) with a large effect size. However, reductions of frequency of headache attacks was not significant.

LIMITATIONS

Potential differential effects of rTMS and tDCS, various sham methods, and potential overlapping headache disorders among included subjects may affect the estimation of effect sizes.

CONCLUSION

Excitatory NIBS of the M1 is likely to reduce headache intensity and the frequency of headache attacks in patients with migraine.

Authors+Show Affiliations

Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China. Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

31535368

Citation

Feng, Yali, et al. "Effects of Non-invasive Brain Stimulation On Headache Intensity and Frequency of Headache Attacks in Patients With Migraine: a Systematic Review and Meta-Analysis." Headache, vol. 59, no. 9, 2019, pp. 1436-1447.
Feng Y, Zhang B, Zhang J, et al. Effects of Non-invasive Brain Stimulation on Headache Intensity and Frequency of Headache Attacks in Patients With Migraine: A Systematic Review and Meta-Analysis. Headache. 2019;59(9):1436-1447.
Feng, Y., Zhang, B., Zhang, J., & Yin, Y. (2019). Effects of Non-invasive Brain Stimulation on Headache Intensity and Frequency of Headache Attacks in Patients With Migraine: A Systematic Review and Meta-Analysis. Headache, 59(9), 1436-1447. https://doi.org/10.1111/head.13645
Feng Y, et al. Effects of Non-invasive Brain Stimulation On Headache Intensity and Frequency of Headache Attacks in Patients With Migraine: a Systematic Review and Meta-Analysis. Headache. 2019;59(9):1436-1447. PubMed PMID: 31535368.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of Non-invasive Brain Stimulation on Headache Intensity and Frequency of Headache Attacks in Patients With Migraine: A Systematic Review and Meta-Analysis. AU - Feng,Yali, AU - Zhang,Bingbing, AU - Zhang,Jiaqi, AU - Yin,Ying, Y1 - 2019/09/18/ PY - 2019/08/11/accepted PY - 2019/9/20/pubmed PY - 2020/7/14/medline PY - 2019/9/20/entrez KW - migraine KW - non-invasive brain stimulation KW - pain KW - transcranial direct current stimulation KW - transcranial magnetic stimulation SP - 1436 EP - 1447 JF - Headache JO - Headache VL - 59 IS - 9 N2 - BACKGROUND: Non-invasive brain stimulation (NIBS) techniques such as repetitive transcranial magnetic stimulation (rTMS), as well as transcranial direct current stimulation (tDCS) electrically stimulate the brain and modify brain activity to suppress pain. This method is emerging as a potential clinical intervention against migraine. OBJECTIVE: To quantitatively review the efficacy of rTMS and tDCS in randomized controlled trials (RCTs) in modifying headache intensity and frequency of headache attacks in patients suffering from migraine. METHODS: We searched 5 databases: PubMed, EMBASE, Web of Science, Cochrane Library, and Scopus for articles from January 2000 to September 2018. Any RCT regarding the efficacy on rTMS and tDCS on patients with migraine, was considered to be included. A random effects meta-analysis was performed to pool effect sizes of outcomes related to headache intensity or frequency of headache attacks. The methodological quality of the included RCTs was assessed using the Physiotherapy Evidence Database scale. RESULTS: Nine RCTs with 276 participants in total (experimental group [EG] = 149; control group [CG] = 127) were included in this review. Five included articles used rTMS (EG = 81; CG = 80), and 4 used tDCS (EG = 68; CG = 47). Meta-analysis of excitatory primary motor cortex (M1) stimulation showed significant effects on reducing headache intensity in patients with migraine (Hedges' g = -0.94; 95% CI, -1.28 to -0.59; P < .001, I2 = 18.39%) with a large effect size. Meta-analysis of excitatory M1 stimulation showed significant effects on reducing frequency of headache attacks in patients with migraine, with a large effect size (Hedges' g = -0.88; 95% CI, -1.38 to -0.38; P = .001, I2 = 57.15%). Excitatory dorsolateral prefrontal cortex stimulation showed a significant effect on the headache intensity in patients with migraine (Hedges' g = -1.14; 95% CI, -2.21 to -0.07; P = .04, I2 = 61.86%) with a large effect size. However, reductions of frequency of headache attacks was not significant. LIMITATIONS: Potential differential effects of rTMS and tDCS, various sham methods, and potential overlapping headache disorders among included subjects may affect the estimation of effect sizes. CONCLUSION: Excitatory NIBS of the M1 is likely to reduce headache intensity and the frequency of headache attacks in patients with migraine. SN - 1526-4610 UR - https://www.unboundmedicine.com/medline/citation/31535368/Effects_of_Non_invasive_Brain_Stimulation_on_Headache_Intensity_and_Frequency_of_Headache_Attacks_in_Patients_With_Migraine:_A_Systematic_Review_and_Meta_Analysis_ L2 - https://doi.org/10.1111/head.13645 DB - PRIME DP - Unbound Medicine ER -