OBJECTIVE: To evaluate the efficacy of noninvasive brain stimulation (NIBS) on pain control in migraine patients. BACKGROUND: Recent studies have used NIBS as an abortive and prophylactic treatment for migraine; however, its efficacy regarding meaningful clinical effects remains to be critically analyzed. DESIGN: Systematic review of controlled clinical trials. METHODS: Searches were conducted in six databases: MEDLINE (via PubMed), LILACS (via BIREME), CINAHL (via EBSCO), Scopus (via EBSCO), Web of Science, and CENTRAL. Two independent authors searched for randomized controlled clinical trials published through until January 2016 that involved the use of transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) in migraineurs. Studies which met the eligibility criteria were assessed and methodological quality was examined using the Cochrane tool for assessing risk of bias. Information about pain intensity (primary outcome), migraine attacks, painkiller intake, and adverse effects were extracted. RESULTS: Eight studies were included in the quantitative analysis with 153 migraine patients that received NIBS and 143 sham NIBS. In overall meta-analysis, we did not find significant results for pain intensity (SMD: -0.61; CI: -1.35 to 0.13; P = .11), for migraine attacks (SMD: -0.44; 95%; CI: -1.15 to 0.26; P = .22), and for painkiller intake (SMD: -0.57; 95% CI: -1.21 to 0.07; P = .08). However, subgroup analysis considering only tDCS effects have demonstrated a decrease for pain intensity (SMD: -0.91; 95% CI: -1.79 to -0.03; P = .04), migraine attacks (SMD: -0.75; 95% CI: -1.25 to -0.24; P = .004), and painkiller intake (SMD: -0.64; 95% CI: -1.21 to -0.07; P = .03). Subgroup analysis for TMS did not reveal significant effects for any outcome. CONCLUSION: Low or very low quality of evidence suggests that our primary outcome evaluation failed to find support for the superiority of NIBS over sham treatment. Although, subgroup analysis reveals that tDCS have moderate to high effects and could be a promising nonpharmacological alternative to pain control, mainly for painkiller intake reduction. However, there is a need for larger controlled trials with methodological rigor, which could increase the power of result inference.
OBJECTIVE: To evaluate the efficacy of noninvasive brain stimulation (NIBS) on pain control in migrainepatients. BACKGROUND: Recent studies have used NIBS as an abortive and prophylactic treatment for migraine; however, its efficacy regarding meaningful clinical effects remains to be critically analyzed. DESIGN: Systematic review of controlled clinical trials. METHODS: Searches were conducted in six databases: MEDLINE (via PubMed), LILACS (via BIREME), CINAHL (via EBSCO), Scopus (via EBSCO), Web of Science, and CENTRAL. Two independent authors searched for randomized controlled clinical trials published through until January 2016 that involved the use of transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) in migraineurs. Studies which met the eligibility criteria were assessed and methodological quality was examined using the Cochrane tool for assessing risk of bias. Information about pain intensity (primary outcome), migraine attacks, painkiller intake, and adverse effects were extracted. RESULTS: Eight studies were included in the quantitative analysis with 153 migrainepatients that received NIBS and 143 sham NIBS. In overall meta-analysis, we did not find significant results for pain intensity (SMD: -0.61; CI: -1.35 to 0.13; P = .11), for migraine attacks (SMD: -0.44; 95%; CI: -1.15 to 0.26; P = .22), and for painkiller intake (SMD: -0.57; 95% CI: -1.21 to 0.07; P = .08). However, subgroup analysis considering only tDCS effects have demonstrated a decrease for pain intensity (SMD: -0.91; 95% CI: -1.79 to -0.03; P = .04), migraine attacks (SMD: -0.75; 95% CI: -1.25 to -0.24; P = .004), and painkiller intake (SMD: -0.64; 95% CI: -1.21 to -0.07; P = .03). Subgroup analysis for TMS did not reveal significant effects for any outcome. CONCLUSION: Low or very low quality of evidence suggests that our primary outcome evaluation failed to find support for the superiority of NIBS over sham treatment. Although, subgroup analysis reveals that tDCS have moderate to high effects and could be a promising nonpharmacological alternative to pain control, mainly for painkiller intake reduction. However, there is a need for larger controlled trials with methodological rigor, which could increase the power of result inference.
Authors: Alberto Herrero Babiloni; Samuel Guay; Donald R Nixdorf; Louis de Beaumont; Gilles Lavigne Journal: J Pain Res Date: 2018-08-01 Impact factor: 3.133
Authors: Abrahão Fontes Baptista; Ana Mércia B L Fernandes; Katia Nunes Sá; Alexandre Hideki Okano; André Russowsky Brunoni; Argelia Lara-Solares; Aziza Jreige Iskandar; Carlos Guerrero; César Amescua-García; Durval Campos Kraychete; Egas Caparelli-Daquer; Elias Atencio; Fabián Piedimonte; Frantz Colimon; Fuad Ahmed Hazime; João Batista S Garcia; John Jairo Hernández-Castro; José Alberto Flores Cantisani; Kátia Karina do Monte-Silva; Luis Claudio Lemos Correia; Manuel Sempértegui Gallegos; Marco Antonio Marcolin; María Antonieta Ricco; María Berenguel Cook; Patricia Bonilla; Pedro Schestatsky; Ricardo Galhardoni; Valquíria Silva; William Delgado Barrera; Wolnei Caumo; Didier Bouhassira; Lucy S Chipchase; Jean-Pascal Lefaucheur; Manoel Jacobsen Teixeira; Daniel Ciampi de Andrade Journal: Pain Rep Date: 2019-01-09