The bottom-up approach: Non-invasive peripheral neurostimulation methods to treat migraine: A scoping review from the child neurologist's perspective

Börner, Corinna; Urban, Giada; Beaulieu, Louis‐David; Sollmann, Nico; Krieg, Sandro M.; Straube, Andreas; Renner, Tabea; Schandelmaier, Paul; Lang, Magdalena; Lechner, Matthias F.; Vill, Katharina; Gerstl, Lucia; Heinen, Florian; Landgraf, Mirjam N.; Bonfert, Michaela

doi:10.1016/j.ejpn.2021.02.008

Cited by 17 publications

(28 citation statements)

References 71 publications

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“…Neurostimulation by rNMS represents a novel approach to acute and preventive treatment in primary headache disorders. Transcutaneous supraorbital nerve stimulation (tSNS) [ 56 , 57 , 58 ], transcutaneous occipital nerve stimulation (tONS) [ 59 , 60 ], and transcutaneous vagus nerve stimulation (tVNS) [ 61 , 62 ] have previously been investigated within this context [ 40 ]. Regarding PTH, no adequate treatments have yet been established, which is why treatment of PTH is commonly based on research in primary headache disorders [ 38 , 63 ].…”

Section: Discussionmentioning

confidence: 99%

“…In comparison to the above-mentioned techniques that stimulate cranial nerves directly, rNMS is not only safe but also well accepted among patients, which is an important factor especially in the pediatric field [ 40 , 41 ]. The key benefit of rNMS is the muscular approach via the UTM, which is clinically involved in the pathophysiology of headache disorders via the TCC [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the choice of the UTM as a stimulation target can be easily explained to the patients (especially in cases of reported neck pain or muscular symptoms together with headache symptoms), who themselves directly experience the stimulation at the local level and control the treatment by being able to adjust stimulation intensity. Hence, rNMS represents a personalized neurostimulation approach from the bottom-up by simultaneously modulating muscular and central pain processing (network reorganization) [ 40 ]. However, studies evaluating the efficacy of rNMS differ in methodology so far, making the use of guidelines for quality improvement of rNMS methods, and thus better comparability of studies, inevitable in the future [ 64 ].…”

Section: Discussionmentioning

confidence: 99%

“…A multimodal therapeutic strategy approaching the burdensome migraine, TTH, and PTH in children, calls for non-invasive, non-pharmacological, safe, and well-accepted treatments [ 39 ]. Neurostimulation of the cranial nerves represents one of the currently increasingly investigated approaches in adult neurology [ 40 ]. As muscular involvement is frequently diagnosed in pediatric headache disorders, a personalized treatment protocol applying repetitive neuromuscular magnetic stimulation (rNMS) targeting the UTM has been recently developed, demonstrating a feasible and safe set-up process and the effective alleviation of headache symptoms [ 41 ].…”

Section: Introductionmentioning

confidence: 99%

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Repetitive Neuromuscular Magnetic Stimulation for Pediatric Headache Disorders: Muscular Effects and Factors Affecting Level of Response

et al. 2022

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Repetitive neuromuscular magnetic stimulation (rNMS) for pediatric headache disorders is feasible, safe, and alleviates headache symptoms. This study assesses muscular effects and factors affecting response to rNMS. A retrospective chart review included children with headaches receiving six rNMS sessions targeting the upper trapezius muscles. Pressure pain thresholds (PPT) were measured before and after rNMS, and at 3-month follow-up (FU). Mean headache frequency, duration, and intensity within the last 3 months were documented. In 20 patients (14.1 ± 2.7 years), PPT significantly increased from pre- to post-treatment (p < 0.001) sustaining until FU. PPT changes significantly differed between primary headache and post-traumatic headache (PTH) (p = 0.019–0.026). Change in headache frequency was significantly higher in patients with than without neck pain (p = 0.032). A total of 60% of patients with neck pain responded to rNMS (≥25%), while 20% of patients without neck pain responded (p = 0.048). 60% of patients receiving rNMS twice a week were responders, while 33% of patients receiving rNMS less or more frequently responded to treatment, respectively. Alleviation of muscular hyperalgesia was demonstrated sustaining for 3 months, which was emphasized in PTH. The rNMS sessions may positively modulate headache symptoms regardless of headache diagnosis. Patients with neck pain profit explicitly well. Two rNMS sessions per week led to the highest reduction in headache frequency.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Repetitive Neuromuscular Magnetic Stimulation for Pediatric Headache Disorders: Muscular Effects and Factors Affecting Level of Response

et al. 2022

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“…It aims at modifying the complex processes and interactions in and in-between the central, peripheral, and/or autonomous nervous system through externally applied electrical or magnetically induced stimuli. Several approaches exist, including: transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), occipital nerve stimulation (ONS), transcutaneous supraorbital nerve stimulation (tSNS), transcutaneous vagus nerve stimulation (tVNS), and remote electrical neurostimulation (REN) of cutaneous sensory afferents of the upper arm (10,(15)(16)(17)(18)(19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

Response Predictors of Repetitive Neuromuscular Magnetic Stimulation in the Preventive Treatment of Episodic Migraine

et al. 2022

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BackgroundRepetitive neuromuscular magnetic stimulation (rNMS) of the trapezius muscles showed beneficial effects in preventing episodic migraine. However, clinical characteristics that predict a favorable response to rNMS are unknown. The objective of this analysis is to identify such predictors.MethodsThirty participants with a diagnosis of episodic migraine (mean age: 24.8 ± 4.0 years, 29 females), who were prospectively enrolled in two non-sham-controlled studies evaluating the effects of rNMS were analyzed. In these studies, the interventional stimulation of the bilateral trapezius muscles was applied in six sessions and distributed over two consecutive weeks. Baseline and follow-up assessments included the continuous documentation of a headache calendar over 30 days before and after the stimulation period, the Migraine Disability Assessment Score (MIDAS) questionnaire (before stimulation and 90 days after stimulation), and measurements of pain pressure thresholds (PPTs) above the trapezius muscles by algometry (before and after each stimulation session). Participants were classified as responders based on a ≥25% reduction in the variable of interest (headache frequency, headache intensity, days with analgesic intake, MIDAS score, left-sided PPTs, right-sided PPTs). Post-hoc univariate and multivariate binary logistic regression analyses were performed.ResultsLower headache frequency (P = 0.016) and intensity at baseline (P = 0.015) and a migraine diagnosis without a concurrent tension-type headache component (P = 0.011) were significantly related to a ≥25% reduction in headache frequency. Higher headache frequency (P = 0.052) and intensity at baseline (P = 0.014) were significantly associated with a ≥25% reduction in monthly days with analgesic intake. Lower right-sided PPTs at baseline were significantly related to a ≥25% increase in right-sided PPTs (P = 0.0.015) and left-sided PPTs (P =0.030). Performance of rNMS with higher stimulation intensities was significantly associated with a ≥25% reduction in headache intensity (P = 0.046).ConclusionsClinical headache characteristics at baseline, the level of muscular hyperalgesia, and stimulation intensity may inform about how well an individual patient responds to rNMS. These factors may allow an early identification of patients that would most likely benefit from rNMS.

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Approach to Pediatric Intractable Migraine

Alqahtani

Barmherzig

Lagman-Bartolome

2021

Curr Neurol Neurosci Rep

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The bottom-up approach: Non-invasive peripheral neurostimulation methods to treat migraine: A scoping review from the child neurologist's perspective

Cited by 17 publications

References 71 publications

Repetitive Neuromuscular Magnetic Stimulation for Pediatric Headache Disorders: Muscular Effects and Factors Affecting Level of Response

Repetitive Neuromuscular Magnetic Stimulation for Pediatric Headache Disorders: Muscular Effects and Factors Affecting Level of Response

Response Predictors of Repetitive Neuromuscular Magnetic Stimulation in the Preventive Treatment of Episodic Migraine

Approach to Pediatric Intractable Migraine

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