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Non-invasive brain stimulation treatments for migraine prophylaxis: a network meta-analysis of randomized controlled trials

Acta Neurologica Belgica volume 123, pages 1481–1493 (2023)Cite this article

Abstract

Background and objectives

Migraine is a major public health problem owing to its long disease duration and disease relapse. Non-invasive brain stimulation treatments were reported effective for the management of migraine, but the comparative effectiveness of three main NIBSs, rTMS, nVNS, and tDCS, has not been studied. We aimed to explore the relative efficacy of rTMS, tDCS, and nVNS in migraine prophylaxis by using network meta-analysis (NMA).

Methods

We searched OVID Medline, Embase, Cochrane Controlled Register of Trials, and Web of Science from inception to 1 January 2022. Randomized controlled trials that reported the efficacy of rTMS, tDCS or nVNS in the prophylactic treatment of migraine were included. The primary outcome was monthly migraine frequency, and secondary outcomes were headache intensity and the impact of headaches on daily life. The relative effects of the treatments in contrast to the others were measured by using standard mean difference (SMD).

Results

We included 31 trials with 1659 participants. Fourteen trials were rated as low risk of bias. The results showed that tDCS (SMD − 1.58; 95%CI, − 2.38 to  − 0.79; P-score = 0.92) had the largest effect on migraine frequency when compared with sham interventions in reducing monthly migraine frequency, and tDCS had a larger effect than rTMS (SMD − 0.62; 95%CI, − 1.81 to 0.57) and nVNS (SMD − 1.39; 95%CI, − 3.27 to 0.49). tDCS had also the largest effect in reducing pain intensity when compared with sham intervention (SMD − 1.49; 95%CI, − 2.46 to  − 0.52) and rTMS (SMD − 0.48; 95%CI, − 2.06 to 1.09).

Conclusions

For the prophylactic treatment of migraine, tDCS was relatively more effective than rTMS and nVNS. Head-to-head comparison trials are needed to confirm the findings.

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Data availability

All authors agree to share the study data after the publication of the article. The data will be acquired upon reasonable request.

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Funding

Hui Zheng received a grant from the Sichuan Youth Science and Technology Innovation Research Team (no. 2021JDTD0007). The sponsors had no role in the design and conduct of the study, and it had no role in the decision process to submit the manuscript for publication.

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Authors and Affiliations

  1. The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu, 610000, China

    Yi-Lin Chen, Qian Chen, Li-Wen Li, Can Hua, Xin-Yue Zhang & Hui Zheng

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  1. Yi-Lin Chen
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  2. Qian Chen
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  3. Li-Wen Li
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  4. Can Hua
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Contributions

All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. HZ: designed the study. YLC, QC, LWL, CH, and XYZ: aquired the study data. YLC and HZ: analyzed the data. YLC: drafted the manuscript. All authors revised the manuscript for important intellectual content and approved it for publication.

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Correspondence to Hui Zheng.

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Chen, YL., Chen, Q., Li, LW. et al. Non-invasive brain stimulation treatments for migraine prophylaxis: a network meta-analysis of randomized controlled trials. Acta Neurol Belg 123, 1481–1493 (2023). https://doi.org/10.1007/s13760-023-02277-z

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