Skip to main content

Advertisement

Log in

A Short Review of the Non-invasive Transcutaneous Pericranial Electrical Stimulation Techniques and their Application in Headache

  • Neuromodulation (M Gofeld, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

In this short review, the most common non-invasive neuromodulatory techniques will be described, along with their advantages and disadvantages and their application in headache. Available preventive treatments can be unhelpful or may have unpleasant side effects; moreover, the rate of response to preventive drugs does not exceed 50%, lower in chronic migraine; alternative options would be welcome. Though the concept of neuromodulation was originally developed with invasive methods, newer non-invasive techniques are appearing.

Recent Findings

The novel neuromodulatory techniques have been developed with encouraging results: compared with traditional pharmacotherapy, advantages of non-invasive neuromodulation include reduced incidence of adverse effects, improved adherence, and safety and ease of use. The results are encouraging for acute or preventive treatment of different kinds of headache.

Summary

A variety of neuromodulatory approaches is expanding fastly and has opened new possibilities for treatment of patients suffering from many forms of headache, especially those who have failed traditional pharmacotherapy. The non-invasive treatments can be seen as supplementing traditional management in refractory patients. Current study results are encouraging but preliminary and larger and more rigorous trials are needed to clarify benefit and mode of action.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Global Burden of Disease Study 2013 Collaborators. Global, regional and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800. https://doi.org/10.1016/S0140-6736(15)60692-4.

    Article  PubMed Central  Google Scholar 

  2. Stewart WF, Wood C, Reed ML, Roy J, Lipton RB. Cumulative lifetime migraine incidence in women and men. Cephalalgia. 2008;28(11):1170–8. https://doi.org/10.1111/j.1468-2982.2008.01666.x.

    Article  CAS  PubMed  Google Scholar 

  3. Fischera M, Marziniak M, Gralow I, Evers S. The incidence and prevalence of cluster headache: a meta-analysis of population-based studies. Cephalalgia. 2008;28(6):614–8. https://doi.org/10.1111/j.1468-2982.2008.01592.

    Article  CAS  PubMed  Google Scholar 

  4. Rizzoli P, Loder E. Tolerance to the beneficial effects of prophylactic migraine drugs: a systematic review of causes and mechanisms. Headache. 2011;51(8):1323–1335. A review evaluating the mechanism for tolerance to preventative medication. https://doi.org/10.1111/j.1526-4610.2011.01985.x.

    Article  PubMed  Google Scholar 

  5. Leone M, Franzini A, Broggi G, Bussone G. Hypothalamic stimulation for intractable cluster headache: long-term experience. Neurology. 2006;67(1):150–2. https://doi.org/10.1212/01.wnl.0000223319.56699.8a.

    Article  PubMed  Google Scholar 

  6. Kahn S, Schoenen J, Ashina M. Sphenopalatine ganglion neuromodulation in migraine: what is the rationale? Cephalalgia. 2014;34(5):382–91. https://doi.org/10.1177/0333102413512032.

    Article  Google Scholar 

  7. Schoenen J, Jensen RH, Lanteri-Minet M, et al. Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study. Cephalalgia. 2013;33(10):816–30. https://doi.org/10.1177/0333102412473667.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lainez M, Jensen R, May A, et al. Long term therapeutic response of sphenopalatine ganglion (SPG) stimulation for cluster headache-pathway CH-1 study (I9-1.007). Neurology. 2014;82(10 Supplement):P7.201.

    Google Scholar 

  9. Wilbrink LA, Teemstra OP, Haan J, et al. Occipital nerve stimulation in medically intractable chronic cluster headache. The ICON study: rationale and protocol of a randomized trial. Cephalalgia. 2013;33(15):1238–47. https://doi.org/10.1177/033310241349035.

    Article  PubMed  Google Scholar 

  10. Reed KL, Black SB, Banta CJ 2nd, Will KR. Combined occipital and supraorbital neurostimulation for the treatment of chronic migraine headaches: initial experience. Cephalalgia. 2010;30(3):260–27. https://doi.org/10.1111/j.1468-2982.2009.01996.

    Article  CAS  PubMed  Google Scholar 

  11. Schoenen J, Vandersmissen B, Jeangette S, Herroelen L, Vandenheede M, Gerard P, et al. Migraine prevention with a supraorbital transcutaneaous stimulator: a randomized controlled study. Neurology. 2013;80(8):697–704. https://doi.org/10.1212/WNL.0b013e3182825055.

    Article  PubMed  Google Scholar 

  12. Barker A, Shields K. Transcranial magnetic stimulation: basic principles and clinical applications in Migraine. Headache Currents. 2017;57(3):517–524. https://doi.org/10.1111/head.13002.

    Article  Google Scholar 

  13. Chervyakov A, Chernyasky AY, Sinitsin DO, Piradov MA. Possible mechanisms underlying the therapeutic effects of transcranial magnetic stimulation. Front Hum Neurosci. 2015;9:303. https://doi.org/10.3389/fnhum.2015.00303.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Clarke BM, Upton AR, Kamath MV, Al-Harbi T, Castellanos CM. Transcranial magnetic stimulation for migraine: clinical effects. J Headache and Pain. 2006;7(5):341–6. https://doi.org/10.1007/s10194-006-0329-8.

    Article  Google Scholar 

  15. Lipton R, Dodick D, Silberstein S, et al. Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: a randomized, double-blind, parallel-group, sham-controlled trial. Lancet Neurol. 2010;9(4):373–80. https://doi.org/10.1016/S1474-4422(10)70054-5. The study reporting outcome from use of sTMS for migraine with aura.

    Article  PubMed  Google Scholar 

  16. Bohla R, Kinsella E, Giffin N, et al. Single-pulse transcranial magnetic stimulation (sTMS) for the acute treatment of migraine: evaluation of outcome data for the UK post market pilot program. J Headache Pain. 2015;16(16):535. https://doi.org/10.1186/s10194-015-0535-3.

    Google Scholar 

  17. Starling A, Tepper S, Marmura MJ, Shamim EA, et al. A Multicenter, Prospective, Single Arm, Open-label, Post-Market, Observational study to evaluate the use of sTMS in reduction of Migraine Headache (ESPOUSE Study). Abstract. Neurology. 2017;16(Supplement S52):004.

    Google Scholar 

  18. Misra U, Kalita J, Bhol S. High rate repetitive transcranial magnetic stimulation (rTMS) in migraine prophylaxis: a randomized, placebo-controlled study. J Neurol. 2013;260(11):2793–801. https://doi.org/10.1007/s00415-013-7072-2.

    Article  PubMed  Google Scholar 

  19. Conforto A, Amaro E, Goncalves A, et al. Randomized, proof-of-principle clinical trial of active transcranial magnetic stimulation in chronic migraine. Cephalalgia. 2014;34(6):464–72. https://doi.org/10.1177/0333102413515340.

    Article  PubMed  Google Scholar 

  20. Dalla Libera D, Colombo B, Nuara A, et al. Repetitive transcranial magnetic stimulation (rTMS) as preventive treatment of chronic migraine; a double-blind, randomized, placebo-controlled study. J Neurol. 2013;260:S199–200.

    Google Scholar 

  21. Lan L, Zhang X, Rong X, Peng Y. The efficacy of transcranial magnetic stimulation on migraine: a meta-analysis of randomized controlled trials. J Hradache & pain. 2017;18(1):86. https://doi.org/10.1186/s10194-017-0792-4.

    Article  Google Scholar 

  22. Schwedt T, Vargas B. Neurostimulation for treatment of migraine and cluster headache. Pain Med. 2015;16(9):1827–34. https://doi.org/10.1111/pme.12792.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Reed KL. Peripheral neuromodulation and headaches: clinical approach, and considerations on underlying mechanisms. Curr Pain and Headache Rep. 2013;17(1):305. https://doi.org/10.1007/s11916-012-0305-8.

    Article  Google Scholar 

  24. Schoenen J, Baschi R, Magis D, Coppola G. Noninvasive neurostimulation methods for migraine therapy: the available evidence. Cephalalgia. 2016;36(120):1170–80. https://doi.org/10.1177/0333102416636022.

    Article  PubMed  Google Scholar 

  25. Riederer F, Penning S, Schoenen J. Transcutaneous supraorbital nerve stimulation 9t-SNS with the Cefaly device for migraine prevention: a review of the available data. Pain Ther. 2015;4(2):135–47. https://doi.org/10.1007/s40122-015-0039-5.

    Article  PubMed Central  Google Scholar 

  26. Schoenen J, Vandersmissen B, Jeangette S, Herroelen L, Vandenheede M, Gerard P, et al. Migraine prevention with a supraorbital transcutaneous stimulator: a randomized controlled trial. Neurology. 2013;80(8):697–704. https://doi.org/10.1212/WNL.0b013e3182825055. Study reporting outcome from use of SNS for migraine.

    Article  PubMed  Google Scholar 

  27. Schoenen J. Addendum to “migraine prevention with a supraorbital transcutaneous stimulator: a randomized controlled trial”. Neurology. 2015;86(8):2–3. https://doi.org/10.1212/WNL.0b013e3182825055.

    Google Scholar 

  28. Russo A, Tessitore A, Conte F, Marcuccio L, Giordano A, Tedeschi G. Transcutaneous supraorbital neurostimulation in “de novo” patients with migraine without aura: the first Italian experience. J Headache Pain. 2015;16(1):69. https://doi.org/10.1186/s10194-015-0551-3.

    Article  PubMed  PubMed Central  Google Scholar 

  29. D’Ostilio K, Thibaut A, Laureys S, et al. Cerebral FDG uptake changes after supraorbital transcutaneous electrical stimulation with the Cefaly® device in patients with migraine. Valencia, Spain: Poster at the HIS conference; 2015. p. 14–7. https://doi.org/10.1177/0333102415606038.

    Google Scholar 

  30. Riederer F, Gantenbein AR, Marti M, Luechinger R, Kollias S, Sandor PS. Decrease of gray matter volume in the midbrain is associated with treatment response in medication overuse headache: possible influence of orbitofrontal cortex. J Neurosci. 2013;33(39):15343–9. https://doi.org/10.1523/JNEUROSCI.3804-12.2013.

    Article  CAS  PubMed  Google Scholar 

  31. Shirahige L, Melo L, Nogueira F, Rocha S, Monte-Silva K. Efficacy of noninvasive brain stimulation on pain control in migraine patients: a systematic review and meta-analysis. Headache. 2016;56(10):1565–96. https://doi.org/10.1111/head.12981.

    Article  PubMed  Google Scholar 

  32. Antal A, Kriener N, Lang N, Boros K, Paulus W. Cathodal transcranial direct current stimulation of the visual cortex in the prophylaxis treatment of migraine. Cephalalgia. 2011;31(7):820–8. https://doi.org/10.1177/0333102411399349.

    Article  PubMed  Google Scholar 

  33. Rocha S, Meolo L, Boudoux C, et al. Transcranial direct current stimulation in the prophylactic treatment of migraine based on interictal visual cortex excitability abnormalities: a pilot randomized controlled trial. J Neurol Sci. 2015;349(1-2):33–9. https://doi.org/10.1016/j.jns.2014.12.018.

    Article  PubMed  Google Scholar 

  34. Auvichayapat P, Janyacharoen T, Rotenberg A, et al. Migraine prophylaxis by anodal transcranial direct current stimulation, a randomized, placebo-controlled trial. J Med Assoc Thail. 2012;95:1003–12. Study reporting outcome from use of tDCS on migraine prophylaxis

    Google Scholar 

  35. DaSilva A, Mendonca M, Zaghi S, et al. tDCS-induced analgesia and electrical fields in pain-related neural networks in chronic migraine. Headache. 2012;52(8):1283–95. https://doi.org/10.1111/j.1526-4610.2012.02141.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Vigano A, D’Elia T, Sava S, et al. Transcranial direct current stimulation (9tDCS) of the visual cortex: a proof-of-concept study based on interictal electrophyological abnormalities in migraine. J Headache Pain. 2013;14(1):23. https://doi.org/10.1186/1129-2377-14-23.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Connor DE Jr, Nixon M, Nanda A, Guthikonda B. Vagal nerve stimulation for the treatment of medically refractory epilepsy: a review of the current literature. Neurosurg Focus 2012 march; 32 (3): E12. https://doi.org/10.3171/2011.12.FOCUS11328.

  38. Grimm S, Bajbouj M. Efficacy of vagus nerve stimulation in the treatment of depression. Expert Rev Neurother. 2010;10(1):87–92. doi:https://doi.org/10.1586/ern.09.138.

    Article  CAS  PubMed  Google Scholar 

  39. Lenaerts M, Oommen K, Couch J, Skaggs V. Can vagus nerve stimulation help migraine? Cephalalgia. 2008;28(4):392–5. https://doi.org/10.1111/j.1468-2982.2008.01538.

    Article  CAS  PubMed  Google Scholar 

  40. Basic S, Sporis D, Chudy D, Grahovac G, Nevajida B. The effect of vagus nerve stimulation on migraine in patient with intractable epilepsy: case report. Neurol Sci. 2013;34(5):797–8. https://doi.org/10.1007/s10072-012-1135-5.

    Article  PubMed  Google Scholar 

  41. Mauskop A. Vagal nerve stimulation relieves chronic refractory migraine and cluster headaches. Cephalalgia. 2005;25(2):82–6. https://doi.org/10.1111/j.1468-2982.2005.00611.

    Article  CAS  PubMed  Google Scholar 

  42. Cecchini Proietti A, Mea E, Tullo V, Curone M, Franzini A, Broggi G, et al. Vagus nerve stimulation in drug-resistant daily chronic migraine with depression: preliminary data. Neurol Sci. 2009;30(Suppl 1):S101–4. https://doi.org/10.1007/s10072-009-0073-3.

    Article  Google Scholar 

  43. Yuan H, Silberstein. Vagus nerve stimulation and headache. Headache. 2017;57:29–33. https://doi.org/10.1111/head.12721.

    Article  PubMed  Google Scholar 

  44. Oshinsky ML, Murphy AL, Hekierski H, Cooper M, Simon BJ. Non invasive vagus nerve stimulation as treatment for trigeminal allodynia. Pain. 2014;155(5):1037–42. https://doi.org/10.1016/j.pain.2014.02.009.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Coppola G, Di Lorenzo C, Serrao M, Parisi V, Schoenen J, Pierelli F. Pathophysiology targets for non pharmacological treatment of migraine. Cephalalgia. 2015;0(0):1–9. https://doi.org/10.1177/0333102415620908.

    Google Scholar 

  46. Chen SP, Ay I, Qin T, et al. Vagus nerve stimulation inhibits cortical spreading depression. Pain. 2016;157(4):797–805. https://doi.org/10.1097/j.pain.0000000000000437.

  47. Goadsby P, Grosberg B, Mauskop A, et al. Effect of noninvasive vagus nerve stimulation on acute migraine: an open-label pilot study. Cephalalgia. 2014;34(12):986–93. https://doi.org/10.1177/0333102414524494.

    Article  CAS  PubMed  Google Scholar 

  48. Barbanti P, Grazzi L, Egeo G, Padovan AM, Liebler E, Bussone G. Non-invasive vagus nerve stimulation for acute treatment of high-frequency and chronic migraine: an open-label study. J Headache Pain. 2015;16(1):543. https://doi.org/10.1186/s10194-015-0542-4.

    Article  Google Scholar 

  49. Grazzi L, Egeo G, Calhoun AH, McClure CK, Liebler E, Barbanti P. Non invasive vagus nerve stimulation (nVNS) as mini prophylaxis for menstrually/menstrually related migraine: an open label study. J Headache and Pain. 2016;17(1):91. https://doi.org/10.1186/s10194-016-0684-z. Study reporting outcome from use of nVNS in menstrual migraine as mini-prophylaxis

    Article  Google Scholar 

  50. Magis D, Gerard P, Schoenen J. Transcutaneous vagus nerve stimulation (tVNS) for headache prophylaxis: initial experience. J Head & pain. 2013;14(S1):198. https://doi.org/10.1186/1129-2377-14-S1-P198.

    Article  Google Scholar 

  51. Silberstein S, DaSilva AN, Calhoun AH, Grosberg BM, Lipton RB, Cady RK, et al. Non-invasive vagus nerve stimulation for chronic migraine prevention in a prospective, randomized, sham-controlled pilot study (the EVENT study): report from the double-blind phase. Headache. 2014;54:1426.

    Article  Google Scholar 

  52. Silberstein S, Calhoun A, Lipton R, Grosberg B, Cady R, et al. Chronic migraine headache prevention with noninvasive vagus nerve stimulation The EVENT study. Neurology. 2016;87(5):529–38. https://doi.org/10.1212/WNL.0000000000002918. Study reporting outcome from use of nVNS as prophylaxis in chronic migraine.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Nesbitt AD, Marin JCA, Tompkins E, Ruttledge MH, Goadsby PJ. Initial experience with a novel non-invasive vagus nerve stimulation device for the treatment of cluster headache. Neurology (Minneap). 2015;84(12):1–5. https://doi.org/10.1212/WNL.0000000000001394.

    Article  Google Scholar 

  54. Silberstein S, Mechtler L, Kudrow D, Calhoun A, et al. Non-Invasive vagus nerve stimulation for the acute treatment of cluster headache: findings from the randomized, double blind, sham-controlled ACT1 Study. Headache. 2016;56:1317–32.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Goadsby P, De Coo IF, Silver N, et al. Non invasive vagus nerve stimulation for the acute treatment of episodic and chronic cluster headache: a randomized, double-blind, sham-controlled ACT2 Study. Cephalalgia. 2017. https://doi.org/10.1177/0333102417744362.

  56. Gaul C, Diener HC, Silver N, Magis D, Reuter U, Andersson A, et al. Non-invasive vagus nerve stimulation for PREVevention and Acute treatment of chronic cluster headache (PREVA): a randomized controlled study. Cephalalgia. 2016;36(6):534–46. https://doi.org/10.1177/0333102415607070. Randomised controlled study reporting outcome form use of nVNS for Chronic Cluster Headache.

    Article  PubMed  Google Scholar 

  57. Grazzi L, Egeo G, Liebler E, Padovan AM, Barbanti P. Non-invasive vagus nerve stimulation (nVNS) as symptomatic treatment of migraine in young patients: a preliminary safety study. Neurol Sci. 2017;38(suppl1):197–9. https://doi.org/10.1007/s10072-017-2942-5.

    Article  PubMed  Google Scholar 

  58. Tassorelli C, Grazzi L, DE Tommaso, et al. Non-invasive vagus nerve stimulation (nVNS) for the acute treatment of migraine: a randomized controlled trial [IHC abstract OC-LB-002]. Cephalalgia. 2017;37(1_suppl):319–20.

  59. Wilkinson D, Ade K, Rogers L, Attix D, Kuchibhatla M, et al. Preventing episodic migraine with caloric vestibular stimulation: a randomized controlled trial. Headache. 2017;57(7):1065–87. https://doi.org/10.1111/head.13120.

    Article  PubMed  Google Scholar 

  60. Yarnitsky D, Volokh L, Ironi V, Weller B, Shor M, Shirifin A, et al. Nonpainful remote electrical stimulation alleviates episodic migraine pain. Neurology. 2017;88(13):1250–5. https://doi.org/10.1212/WNL.0000000000003760.

    Article  PubMed  Google Scholar 

  61. Puledda F, Goadsby P. Current approaches to neuromodulation primary headaches: focus on vagal nerve and sphenopalatine ganglion stimulation. Curr Pain and Headache Rep. 2016;20(7):47. https://doi.org/10.1007/s11916-016-0577-5.

    Article  Google Scholar 

  62. Martelletti P, Jensen RH, Antal A, Arcioni R, Brighina F, De Tommaso M, et al. Neuromodulation of chronic headaches: position statement from the European Headache Federation. Journal of Headache & Pain. 2013;14(1):86. https://doi.org/10.1186/1129-2377-14-86. EFNS guidelines for the use of neuromodulation techniques

    Article  Google Scholar 

  63. Leone M. Costs of hypothalamic stimulation in chronic drug-resistant cluster headache: preliminary data. Neurol Sci. 2009;30(Suppl 1):43–7. https://doi.org/10.1007/s10072-009-0057-3.

    Article  Google Scholar 

  64. Morris J, Straube A, Diener HC, Ahmed F, Silver N, Walker S, et al. Cost-effectiveness analysis of non-invasive vagus nerve stimulation for the treatment of chronic cluster headache. J Headache Pain. 2016;17:43. https://doi.org/10.1186/s10194-016-0633. Evaluation of the cost-effectiveness of nVNS for Chronic Cluster Headache compared to standard treatment.

  65. Diener HC, Bingel U. Surgical treatment for migraine: time to fight against the knife. Cephalalgia. 2015;35(6):2015–468. https://doi.org/10.1177/0333102414545895.

    Article  Google Scholar 

  66. Ambrosini A, D’Alessio C, Magis D, Schoenen J. Targeting pericranial nerve branches to treat migraine: current approaches and perspectives. Cephalalgia. 2015;35(14):1308–22. https://doi.org/10.1177/0333102415573511.

    Article  PubMed  Google Scholar 

  67. Matharu M, Miller S. Non-invasive neuromodulation in primary headache. Curr Pain and Headache Rep. 2017;21(3):14. https://doi.org/10.1007/s11916-017-0608-x.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Licia Grazzi.

Ethics declarations

Conflict of Interest

Licia Grazzi, Emanuela Sansone, and Paul Rizzoli declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Neuromodulation

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Grazzi, L., Sansone, E. & Rizzoli, P. A Short Review of the Non-invasive Transcutaneous Pericranial Electrical Stimulation Techniques and their Application in Headache. Curr Pain Headache Rep 22, 4 (2018). https://doi.org/10.1007/s11916-018-0654-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-018-0654-z

Keywords

Navigation