OBJECTIVE. To evaluate the safety and the efficacy of non-invasive vagal nerve stimulation (nVNS) for the treatment of headache attacks in patients with chronic migraine and medication overuse headache (CM/MOH) after a detoxification period.BACKGROUND. Approximately 20% of migraine patients develop CM/MOH. Medical treatment of CM/MOH patients is often challenging and neuromodulation is emerging as a new therapeutic option. Gammacore® is a portable non-invasive stimulator that produces a mild electrical signal transmitted to the vagus nerve through the skin. Preliminary reports suggested that migraine patients experience a reduction in the severity of their headache symptoms with nVNS.METHODS. Fifteen CM-MOH patients (1 man, 14 women; mean age ± SD = 49.9 ± 15.8 yrs) were enrolled in the study. Patients underwent a 5-day in-patient detoxification period and were then followed for a 6-month period. Headache attacks during the detoxification period and in the 6-month follow-up period were treated with repeated nVNS. The clinical characteristics of headaches were recorded in headache diaries.RESULTS. 362 migraine attacks were treated with nVNS during the study. At two-hours, a pain-free response was observed in 121/362 (33.4%). Average initial pain levels was 1.66 ± 0.7 and dropped to 1.1 ± 0.9 at two hours (p<0.001). A significant response to nVNS was observed in 50% of treated patients. Rescue medications were used in 67 (18.5%) of the attacks treated with Gammacore. Treatment related adverse events were frequent but mild.CONCLUSIONS. Our study shows that nVNS could be an efficient and safe treatment in patients with CM/MOH after detoxification. Additional studies in order to evaluate the long-term efficacy of this treatment are needed.
Non-invasive Vagal Nerve Stimulation for the Treatment of Headache Attacks in Patients with Chronic Migraine and Medication-Overuse Headache
RAINERO, Innocenzo;RUBINO, Elisa;PINESSI, Lorenzo
2014-01-01
Abstract
OBJECTIVE. To evaluate the safety and the efficacy of non-invasive vagal nerve stimulation (nVNS) for the treatment of headache attacks in patients with chronic migraine and medication overuse headache (CM/MOH) after a detoxification period.BACKGROUND. Approximately 20% of migraine patients develop CM/MOH. Medical treatment of CM/MOH patients is often challenging and neuromodulation is emerging as a new therapeutic option. Gammacore® is a portable non-invasive stimulator that produces a mild electrical signal transmitted to the vagus nerve through the skin. Preliminary reports suggested that migraine patients experience a reduction in the severity of their headache symptoms with nVNS.METHODS. Fifteen CM-MOH patients (1 man, 14 women; mean age ± SD = 49.9 ± 15.8 yrs) were enrolled in the study. Patients underwent a 5-day in-patient detoxification period and were then followed for a 6-month period. Headache attacks during the detoxification period and in the 6-month follow-up period were treated with repeated nVNS. The clinical characteristics of headaches were recorded in headache diaries.RESULTS. 362 migraine attacks were treated with nVNS during the study. At two-hours, a pain-free response was observed in 121/362 (33.4%). Average initial pain levels was 1.66 ± 0.7 and dropped to 1.1 ± 0.9 at two hours (p<0.001). A significant response to nVNS was observed in 50% of treated patients. Rescue medications were used in 67 (18.5%) of the attacks treated with Gammacore. Treatment related adverse events were frequent but mild.CONCLUSIONS. Our study shows that nVNS could be an efficient and safe treatment in patients with CM/MOH after detoxification. Additional studies in order to evaluate the long-term efficacy of this treatment are needed.
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