Effectiveness and acceptability of noninvasive brain and nerve stimulation techniques for migraine prophylaxis: a network meta-analysis of randomized controlled trials

Yu-Chen Cheng; Bing-Yan Zeng; Chao-Ming Hung; Kuan-Pin Su; Yi-Cheng Wu; Yu-Kang Tu; Pao-Yen Lin; Brendon Stubbs; Andre F Carvalho; Chih-Sung Liang; Tien-Yu Chen; Chih-Wei Hsu; Andre R Brunoni; Mein-Woei Suen; Yow-Ling Shiue; Ping-Tao Tseng; Ming-Kung Wu; Cheng-Ta Li

doi:10.1186/s10194-022-01401-3

Effectiveness and acceptability of noninvasive brain and nerve stimulation techniques for migraine prophylaxis: a network meta-analysis of randomized controlled trials

J Headache Pain. 2022 Feb 20;23(1):28. doi: 10.1186/s10194-022-01401-3.

Authors

Yu-Chen Cheng^#^{1

2

3}, Bing-Yan Zeng^#⁴, Chao-Ming Hung^#^{5

6}, Kuan-Pin Su^{7

8

9}, Yi-Cheng Wu¹⁰, Yu-Kang Tu^{11

12}, Pao-Yen Lin^{13

14}, Brendon Stubbs^{15

16

17}, Andre F Carvalho¹⁸, Chih-Sung Liang^{19

20}, Tien-Yu Chen^{21

22}, Chih-Wei Hsu¹³, Andre R Brunoni^{23

24}, Mein-Woei Suen^{25

26

27

28}, Yow-Ling Shiue²⁹, Ping-Tao Tseng^{30

31

32}, Ming-Kung Wu³³, Cheng-Ta Li^{34

35

36

37

38}

Affiliations

¹ Department of Neurology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.
² Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
³ Division of Community & Rehabilitation Psychiatry, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
⁴ Department of Internal Medicine, E-DA Dachang Hospital, Kaohsiung, Taiwan.
⁵ Division of General Surgery, Department of Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan.
⁶ School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
⁷ Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan.
⁸ College of Medicine, China Medical University, Taichung, Taiwan.
⁹ An-Nan Hospital, China Medical University, Tainan, Taiwan.
¹⁰ Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan.
¹¹ Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
¹² Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
¹³ Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist, Kaohsiung City, 833, Taiwan.
¹⁴ Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
¹⁵ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹⁶ Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.
¹⁷ Positive Ageing Research Institute (PARI), Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK.
¹⁸ Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia.
¹⁹ Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan.
²⁰ Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
²¹ Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.
²² Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan.
²³ Service of Interdisciplinary Neuromodulation, National Institute of Biomarkers in Psychiatry, Laboratory of Neurosciences (LIM-27), Departamento e Instituto de Psiquiatria, Faculdade de Medicina da USP, São Paulo, Brazil.
²⁴ Departamento de Ciências Médicas, Faculdade de Medicina da USP, São Paulo, Brazil.
²⁵ Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
²⁶ Gender Equality Education and Research Center, Asia University, Taichung, Taiwan.
²⁷ Department of Medical Research, Asia University Hospital, Asia University, Taichung, Taiwan.
²⁸ Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
²⁹ Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.
³⁰ Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan. ducktseng@gmail.com.
³¹ Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan. ducktseng@gmail.com.
³² Prospect Clinic for Otorhinolaryngology & Neurology, No. 252, Nanzixin Road, Nanzi District, Kaohsiung City, 81166, Taiwan. ducktseng@gmail.com.
³³ Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist, Kaohsiung City, 833, Taiwan. mingkung180@gmail.com.
³⁴ Division of Community & Rehabilitation Psychiatry, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan. on5083@msn.com.
³⁵ Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan. on5083@msn.com.
³⁶ Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City, 11267, Taiwan. on5083@msn.com.
³⁷ Institute of Brain Science and Brain Research Center, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. on5083@msn.com.
³⁸ Functional Neuroimaging and Brain Stimulation Lab, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City, 11267, Taiwan. on5083@msn.com.

^# Contributed equally.

Abstract

Background: Current pharmacologic prophylactic strategies for migraine have exhibited limited efficacy, with response rates as low as 40%-50%. In addition to the limited efficacy, the acceptability of those pharmacologic prophylactic strategies were unacceptable. Although noninvasive brain/nerve stimulation strategies may be effective, the evidence has been inconsistent. The aim of this network meta-analysis (NMA) was to compare strategies of noninvasive brain/nerve stimulation for migraine prophylaxis with respect to their effectiveness and acceptability.

Methods: The PubMed, Embase, ScienceDirect, ProQuest, ClinicalTrials.gov , ClinicalKey, Cochrane CENTRAL, Web of Science, and ClinicalTrials.gov databases were systematically searched to date of June 4th, 2021 for randomized controlled trials (RCTs). Patients with diagnosis of migraine, either episodic migraine or chronic migraine, were included. All NMA procedures were conducted under the frequentist model.

Results: Nineteen RCTs were included (N = 1493; mean age = 38.2 years; 82.0% women). We determined that the high frequency repetitive transcranial magnetic stimulation (rTMS) over C3 yielded the most decreased monthly migraine days among all the interventions [mean difference = - 8.70 days, 95% confidence intervals (95%CIs): - 14.45 to - 2.95 compared to sham/control groups]. Only alternating frequency (2/100 Hz) transcutaneous occipital nerve stimulation (tONS) over the Oz (RR = 0.36, 95%CIs: 0.16 to 0.82) yielded a significantly lower drop-out rate than the sham/control groups did.

Conclusions: The current study provided a new direction for the design of more methodologically robust and larger RCTs based on the findings of the potentially beneficial effect on migraine prophylaxis in participants with migraine by different noninvasive brain/nerve stimulation, especially the application of rTMS and tONS.

Trial registration: CRD42021252638. The current study had been approval by the Institutional Review Board of the Tri-Service General Hospital, National Defense Medical Center (TSGHIRB No. B-109-29).

Keywords: Migraine; Network meta-analysis; Non-invasive brain stimulation; Non-invasive nerve stimulation; Response rate.

Publication types

Meta-Analysis

MeSH terms

Adult
Brain
Female
Humans
Male
Migraine Disorders* / prevention & control
Network Meta-Analysis
Randomized Controlled Trials as Topic
Transcranial Magnetic Stimulation / methods