Neuromodulation in the Treatment of Migraine: Progress in Nerve Stimulation

Abstract

Migraine is a type of primary headache disorder that can become chronic and disabling. The
exact pathomechanism of migraine is not known very well and its treatment is also difficult in
some cases. There are several medications for the acute and preventive treatment of migraine
including the “triptan” family drugs, nonsteroidal anti-inflammatory drugs, anti-epileptic drugs,
beta-blockers, and Ca2+-channel blockers1 and those against calcitonin gene-related peptide or
its receptor that are reviewed elsewhere.2 However, there are some medically intractable headaches
or patient management is unsatisfactory or medications are poorly tolerated3 or there
are contraindications. Therefore, neuromodulation and nerve stimulation methods that have
proven effective in clinical research may provide an additional treatment option for acute and
preventive treatment of migraine. In this brief review, we will discuss recent advances using
neuromodulatory techniques that are currently used in the treatment of headaches in clinical
studies. These include the electrical stimulation of occipital nerve, sphenopalatine ganglion,
supraorbital nerve, and transcutaneous electrical stimulation of vagus nerve as well as singlepulse
transcranial magnetic stimulation. Several clinical studies have conducted neurostimulation
for the acute and preventive treatment of migraine in recent years but more studies are
necessary to see their efficacy and long-term effect.