Noninvasive neurostimulation methods for migraine therapy: The available evidence

Abstract
Background: Migraine is one of the most disabling neurological disorders. The current pharmacological armamentarium
is not satisfying for a large proportion of patients because the responder rate does not exceed 50% on average and
the most effective drugs often induce intolerable side effects. During recent years, noninvasive central and peripheral
neuromodulation methods have been explored for migraine treatment.
Overview: A review of the available evidence suggests that noninvasive neuromodulation techniques could be beneficial
for migraine patients. The transcranial stimulation methods allow modulating selectively cortical activity and can thus be
curtailed to the patient’s pathophysiological profile, while transcutaneous stimulation of pericranial nerves likely modulates
central pain control centers. Occipital single-pulse transcranial magnetic stimulation and transcutaneous supraorbital
stimulation have the strongest evidence respectively for acute and preventive treatment. Transcranial direct
current stimulation and repetitive magnetic stimulation are promising in pilot studies, but large sham-controlled trials
are not yet available.
Conclusions: The noninvasive neurostimulation methods are promising for migraine treatment and devoid of serious
adverse effects allowing their combination with drug therapies. Their application in clinical practice will depend on the
industry’s capacity to develop portable and user-friendly devices, and on the scientists’ capacity to prove their efficacy in randomized sham-controlled trials.