Which is the best transcranial direct current stimulation protocol for migraine prevention? A systematic review and critical appraisal of randomized controlled trials

Abstract Background Transcranial direct current stimulation (tDCS) could counteract the pathophysiological triggers of migraine attacks by modulating cortical excitability. Several pilot randomized controlled trials (RCTs) assessed the efficacy of tDCS for migraine prevention. We reviewed and summar...

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Autores principales:	Raffaele Ornello, Valeria Caponnetto, Susanna Ratti, Giulia D’Aurizio, Chiara Rosignoli, Francesca Pistoia, Michele Ferrara, Simona Sacco, Aurora D’Atri
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Transcranial direct current stimulation migraine non-pharmacological treatment migraine prevention Medicine R
Acceso en línea:	https://doaj.org/article/d9470f83ff57435bb5bd307bf8726580
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spelling	oai:doaj.org-article:d9470f83ff57435bb5bd307bf87265802021-11-28T12:36:38ZWhich is the best transcranial direct current stimulation protocol for migraine prevention? A systematic review and critical appraisal of randomized controlled trials10.1186/s10194-021-01361-01129-23691129-2377https://doaj.org/article/d9470f83ff57435bb5bd307bf87265802021-11-01T00:00:00Zhttps://doi.org/10.1186/s10194-021-01361-0https://doaj.org/toc/1129-2369https://doaj.org/toc/1129-2377Abstract Background Transcranial direct current stimulation (tDCS) could counteract the pathophysiological triggers of migraine attacks by modulating cortical excitability. Several pilot randomized controlled trials (RCTs) assessed the efficacy of tDCS for migraine prevention. We reviewed and summarized the state of the art of tDCS protocols for migraine prevention, discussing study results according to the stimulations parameters and patients’ populations. Main body We combined the keywords ‘migraine’, ‘headache’, ‘transcranial direct current stimulation’, and ‘tDCS’ and searched Pubmed, Scopus, and Web of Science, from the beginning of indexing to June 22, 2021. We only included RCTs comparing the efficacy of active tDCS with sham tDCS to decrease migraine frequency, intensity, and/or acute drug utilization. The risk of bias of each RCT was assessed by using the RoB-2 tool (Cochrane Collaboration). Thirteen RCTs (from 2011 to 2021) were included in the review. The included patients ranged from 13 to 135. RCTs included patients with any migraine (n=3), chronic migraine (n=6), episodic migraine (n=3) or menstrual migraine (n=1). Six RCTs used cathodal and five anodal tDCS, while two RCTs compared the efficacy of both cathodal and anodal tDCS with that of sham. In most of the cathodal stimulation trials, the target areas were the occipital regions, with reference on central or supraorbital areas. In anodal RCTs, the anode was usually placed above the motor cortical areas and the cathode on supraorbital areas. All RCTs adopted repeated sessions (from 5 to 28) at variable intervals, while the follow-up length spanned from 1 day up to 12 months. Efficacy results were variable but overall positive. According to the RoB-2 tool, only four of the 13 RCTs had a low risk of bias, while the others presented some concerns. Conclusions Both anodal and cathodal tDCS are promising for migraine prevention. However, there is a need for larger and rigorous RCTs and standardized procedures. Additionally, the potential benefits and targeted neurostimulation protocols should be assessed for specific subgroups of patients.Raffaele OrnelloValeria CaponnettoSusanna RattiGiulia D’AurizioChiara RosignoliFrancesca PistoiaMichele FerraraSimona SaccoAurora D’AtriBMCarticleTranscranial direct current stimulationmigrainenon-pharmacological treatmentmigraine preventionMedicineRENThe Journal of Headache and Pain, Vol 22, Iss 1, Pp 1-13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Transcranial direct current stimulation migraine non-pharmacological treatment migraine prevention Medicine R
spellingShingle	Transcranial direct current stimulation migraine non-pharmacological treatment migraine prevention Medicine R Raffaele Ornello Valeria Caponnetto Susanna Ratti Giulia D’Aurizio Chiara Rosignoli Francesca Pistoia Michele Ferrara Simona Sacco Aurora D’Atri Which is the best transcranial direct current stimulation protocol for migraine prevention? A systematic review and critical appraisal of randomized controlled trials
description	Abstract Background Transcranial direct current stimulation (tDCS) could counteract the pathophysiological triggers of migraine attacks by modulating cortical excitability. Several pilot randomized controlled trials (RCTs) assessed the efficacy of tDCS for migraine prevention. We reviewed and summarized the state of the art of tDCS protocols for migraine prevention, discussing study results according to the stimulations parameters and patients’ populations. Main body We combined the keywords ‘migraine’, ‘headache’, ‘transcranial direct current stimulation’, and ‘tDCS’ and searched Pubmed, Scopus, and Web of Science, from the beginning of indexing to June 22, 2021. We only included RCTs comparing the efficacy of active tDCS with sham tDCS to decrease migraine frequency, intensity, and/or acute drug utilization. The risk of bias of each RCT was assessed by using the RoB-2 tool (Cochrane Collaboration). Thirteen RCTs (from 2011 to 2021) were included in the review. The included patients ranged from 13 to 135. RCTs included patients with any migraine (n=3), chronic migraine (n=6), episodic migraine (n=3) or menstrual migraine (n=1). Six RCTs used cathodal and five anodal tDCS, while two RCTs compared the efficacy of both cathodal and anodal tDCS with that of sham. In most of the cathodal stimulation trials, the target areas were the occipital regions, with reference on central or supraorbital areas. In anodal RCTs, the anode was usually placed above the motor cortical areas and the cathode on supraorbital areas. All RCTs adopted repeated sessions (from 5 to 28) at variable intervals, while the follow-up length spanned from 1 day up to 12 months. Efficacy results were variable but overall positive. According to the RoB-2 tool, only four of the 13 RCTs had a low risk of bias, while the others presented some concerns. Conclusions Both anodal and cathodal tDCS are promising for migraine prevention. However, there is a need for larger and rigorous RCTs and standardized procedures. Additionally, the potential benefits and targeted neurostimulation protocols should be assessed for specific subgroups of patients.
format	article
author	Raffaele Ornello Valeria Caponnetto Susanna Ratti Giulia D’Aurizio Chiara Rosignoli Francesca Pistoia Michele Ferrara Simona Sacco Aurora D’Atri
author_facet	Raffaele Ornello Valeria Caponnetto Susanna Ratti Giulia D’Aurizio Chiara Rosignoli Francesca Pistoia Michele Ferrara Simona Sacco Aurora D’Atri
author_sort	Raffaele Ornello
title	Which is the best transcranial direct current stimulation protocol for migraine prevention? A systematic review and critical appraisal of randomized controlled trials
title_short	Which is the best transcranial direct current stimulation protocol for migraine prevention? A systematic review and critical appraisal of randomized controlled trials
title_full	Which is the best transcranial direct current stimulation protocol for migraine prevention? A systematic review and critical appraisal of randomized controlled trials
title_fullStr	Which is the best transcranial direct current stimulation protocol for migraine prevention? A systematic review and critical appraisal of randomized controlled trials
title_full_unstemmed	Which is the best transcranial direct current stimulation protocol for migraine prevention? A systematic review and critical appraisal of randomized controlled trials
title_sort	which is the best transcranial direct current stimulation protocol for migraine prevention? a systematic review and critical appraisal of randomized controlled trials
publisher	BMC
publishDate	2021
url	https://doaj.org/article/d9470f83ff57435bb5bd307bf8726580
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Which is the best transcranial direct current stimulation protocol for migraine prevention? A systematic review and critical appraisal of randomized controlled trials

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