The efficacy of transcranial direct current stimulation in patients with medication overuse headaches secondary to chronic migraines (P4.128)

Abstract

Objective: Evaluate the efficacy of transcranial direct current stimulation (tDCS) to treat medication overuse headaches (MOH).

Background: Patients with occasional migraines use more abortive medications to treat their headaches. They render their medications less effective and develop daily medication overuse headaches (MOH) notoriously difficult to treat. Alternatives to pharmacological treatment are badly needed.

Design/Methods: 16 patients with MOH (age: 20–38, 13 women) were randomly assigned in a crossover design to receive 3 consecutive sessions: sham, cathodal tDCS stimulation (2.0 mA, 20 min) over the visual cortex of the dominant side of the migraine pain (O1/O2), and anodal tDCS stimulation over the left dorsolateral prefrontal cortex (DLPFC). Patients filled a migraine diary to record the intensity of pain (using a visual analogue scale) and the number of analgesic pills taken daily for a period extending from one week before (W−1) to one and two weeks after stimulation (W+1 and W+2).

Results: We found a statistically significant reduction in the days of severe migraine attacks as compared to baseline (Sham, W−1) for both the Occipital (W+1: 1.06 vs 1.81 p=0.047; W+2: 0.75 vs 1.375 p=0.045) and DLPFC groups (W+1: 0.812 vs 1.81 p=0.015). The analgesic medication use were significantly reduced in the DLPFC group at W+2 (1.66 vs 2.22, p=0.002). The pain intensity was significantly reduced in the Occipital group (W+1: 2.71 vs 4.29, p=0.02). No serious side effects were observed. The procedure was well tolerated.

Conclusions: Our results show that cathodal tDCS over the visual cortex and anodal tDCS over the left DLPFC have a significant analgesic effect in MOH and effectively decrease the number of severe migraine days. There was also a significant decrease in the consumption of analgesic medications in the DLPFC group and in the pain intensity in the Occipital group.

Disclosure: Dr. Riachi has nothing to disclose. Dr. Mansour has nothing to disclose. Dr. Salem has nothing to disclose. Dr. Khoury has nothing to disclose. Dr. Sabbouh has nothing to disclose. Dr. Jabri has nothing to disclose. Dr. Khazen has nothing to disclose. Dr. Ahdab has nothing to disclose.