Neuromodulation in migraine: state of the art and perspectives.
in Expert review of medical devices (2015)
Migraine is a highly prevalent and disabling disease. The drugs prescribed for migraine prophylaxis can have intolerable side effects or can be ineffective. Neuromodulation techniques are increasingly ... [more ▼]
Migraine is a highly prevalent and disabling disease. The drugs prescribed for migraine prophylaxis can have intolerable side effects or can be ineffective. Neuromodulation techniques are increasingly used in neurology. Transcutaneous supraorbital nerve stimulation is effective in episodic migraine prevention, whereas vagus nerve stimulation provides interesting results in acute migraine therapy. Transcranial stimulation techniques gave variable, and sometimes contradictory, results. The visual cortex is the target of choice in migraine: studies in migraine prevention and aura acute treatment are encouraging. These noninvasive therapies appear safe with a low rate of side effects. Available studies of invasive occipital nerve stimulation in chronic migraine gave modest results; but invasive occipital nerve stimulation offers a new hope to highly disabled patients who failed to respond to any other treatment. In the future, neuromodulation will probably take an increasing place in migraine treatment, as add-on therapy or alternative to medications, especially because of its attractive safety profile. [less ▲]Detailed reference viewed: 22 (1 ULg)
Neuromodulation in cluster headache.
; ; MAGIS, Delphine et al
in Advances and technical standards in neurosurgery (2015), 42
Medically refractory chronic cluster headache (CH) is a severely disabling headache condition for which several surgical procedures have been proposed as a prophylactic treatment. None of them have been ... [more ▼]
Medically refractory chronic cluster headache (CH) is a severely disabling headache condition for which several surgical procedures have been proposed as a prophylactic treatment. None of them have been evaluated in controlled conditions, only open studies and case series being available. Destructive procedures (radiofrequency lesioning, radiosurgery, section) and microvascular decompression of the trigeminal nerve or the sphenopalatine ganglion (SPG) have induced short-term improvement which did not maintain on long term in most of the patients. They carried a high risk of complications, including severe sensory loss and neuropathic pain, and consequently should not be proposed in first intention.Deep brain stimulation (DBS), targeting the presumed CH generator in the retro-hypothalamic region or fibers connecting it, decreased the attack frequency >50 in 60 % of the 52 patients reported. Complications were infrequent: gaze disturbances, autonomic disturbances, and intracranial hemorrhage (2).Occipital nerve stimulation (ONS) was efficient (decrease of attack frequency >50 %) in about 70 % of the 60 patients reported, with a low risk of complications (essentially hardware related). Considering their respective risks, ONS should be proposed first and DBS only in case of ONS failure.New on-demand chronically implanted SPG stimulation seemed to be efficient to abort CH attacks in a pilot controlled trial, but its long-term safety needs to be further studied. [less ▲]Detailed reference viewed: 9 (1 ULg)
Refractory chronic migraine: a consensus statement on clinical definition from the European Headache Federation.
; ; et al
in The journal of headache and pain (2014), 15
The debate on the clinical definition of refractory Chronic Migraine (rCM) is still far to be concluded. The importance to create a clinical framing of these rCM patients resides in the complete ... [more ▼]
The debate on the clinical definition of refractory Chronic Migraine (rCM) is still far to be concluded. The importance to create a clinical framing of these rCM patients resides in the complete disability they show, in the high risk of serious adverse events from acute and preventative drugs and in the uncontrolled application of therapeutic techniques not yet validated.The European Headache Federation Expert Group on rCM presents hereby the updated definition criteria for this harmful subset of headache disorders. This attempt wants to be the first impulse towards the correct identification of these patients, the correct application of innovative therapeutic techniques and lastly aim to be acknowledged as clinical entity in the next definitive version of the International Classification of Headache Disorders 3 (ICHD-3 beta). [less ▲]
Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society.
; ; MAGIS, Delphine et al
in Acta neurologica Belgica (2014)
Chronic migraine (CM) is a disabling neurological condition affecting 0.5-2 % of the population. In the current third edition of the International Classification of Headache Disorders, medication overuse ... [more ▼]
Chronic migraine (CM) is a disabling neurological condition affecting 0.5-2 % of the population. In the current third edition of the International Classification of Headache Disorders, medication overuse is no longer an exclusion criterion and CM is diagnosed in patients suffering from at least 15 headache days per month of which at least eight are related to migraine. CM is difficult to treat, and preventive treatment options are limited. We provide a pathogenetic model for CM, integrating the latest findings from neurophysiological and neuroimaging studies. On behalf of the Belgian Headache Society, we present a management algorithm for CM based on the international literature and adapted to the Belgian situation. Pharmacological treatment options are discussed, and recent data on transcranial and invasive neuromodulation studies in CM are reviewed. An integrated multimodal treatment programme may be beneficial to refractory patients, but at present, this approach is only supported by a limited number of observational studies and quite variable between centres. [less ▲]Detailed reference viewed: 17 (1 ULg)
Effects of visual cortex activation on the nociceptive blink reflex in healthy subjects.
; ; MAGIS, Delphine et al
in PloS one (2014), 9(6), 100198
Bright light can cause excessive visual discomfort, referred to as photophobia. The precise mechanisms linking luminance to the trigeminal nociceptive system supposed to mediate this discomfort are not ... [more ▼]
Bright light can cause excessive visual discomfort, referred to as photophobia. The precise mechanisms linking luminance to the trigeminal nociceptive system supposed to mediate this discomfort are not known. To address this issue in healthy human subjects we modulated differentially visual cortex activity by repetitive transcranial magnetic stimulation (rTMS) or flash light stimulation, and studied the effect on supraorbital pain thresholds and the nociceptive-specific blink reflex (nBR). Low frequency rTMS that inhibits the underlying cortex, significantly decreased pain thresholds, increased the 1st nBR block ipsi- and contralaterally and potentiated habituation contralaterally. After high frequency or sham rTMS over the visual cortex, and rMS over the right greater occipital nerve we found no significant change. By contrast, excitatory flash light stimulation increased pain thresholds, decreased the 1st nBR block of ipsi- and contralaterally and increased habituation contralaterally. Our data demonstrate in healthy subjects a functional relation between the visual cortex and the trigeminal nociceptive system, as assessed by the nociceptive blink reflex. The results argue in favour of a top-down inhibitory pathway from the visual areas to trigemino-cervical nociceptors. We postulate that in normal conditions this visuo-trigeminal inhibitory pathway may avoid disturbance of vision by too frequent blinking and that hypoactivity of the visual cortex for pathological reasons may promote headache and photophobia. [less ▲]Detailed reference viewed: 6 (1 ULg)
Analysis and clinical correlates of 20 Hz photic driving on routine EEG in migraine.
; Gérard, Paul ; et al
in Acta neurologica Belgica (2014)
Enhanced photic driving (PD) during high-frequency flicker stimulation, the so-called H response, is a classical feature of migraine patients between attacks, but is thought to be of poor clinical utility ... [more ▼]
Enhanced photic driving (PD) during high-frequency flicker stimulation, the so-called H response, is a classical feature of migraine patients between attacks, but is thought to be of poor clinical utility. Visual inspection of the EEG for its detection may not be reliable, however, data on its possible correlations with clinical features and migraine pathophysiology are scarce. We have compared visual inspection and EEG spectral analysis to detect abnormal PD in 280 consecutive migraine patients of our headache clinic (episodic migraine without aura, n = 171; chronic migraine, n = 48; migraine with aura, n = 61) and in a group of 24 non-migrainous neurological controls. Spectral frequency analyses were performed blindly by one of us (YF). On visual inspection, 50.4 % of migraineurs were thought to have increased 20 Hz PD. After spectral analysis, only 62.4 % of them had PD power superior to the mean + 95 % CI of the control group. Sensitivity of visually identified PD was 82.24 %, specificity 69.36 %. Increased PD on spectral analysis was more prevalent in episodic migraine than in chronic migraine, in patients with low attack frequency, in those with ictal autonomic symptoms in addition to nausea and in those with a strong family history of migraine. We confirm therefore that 20 Hz photic driving is of little diagnostic utility and its prevalence in migraine overestimated on visual inspection. Its presence on spectral analysis of the EEG, however, might be of pathophysiological interest, as it identifies subgroups of migraineurs of whom the common denominator could be lack of habituation of cortical responses during repetitive stimulation. [less ▲]Detailed reference viewed: 1 (0 ULg)
Neurostimulation for Headaches: Where Are We? Where Are We Going?
in May, Arne; Baron, Ralf (Eds.) Headache and Pain (2014)Detailed reference viewed: 15 (0 ULg)
Variabilité du spectre clinique des céphalées trigéminales autonomes: 2 cas illustratifs
in Revue Neurologique (2014), 170Detailed reference viewed: 20 (0 ULg)
Safety and patients' satisfaction of transcutaneous supraorbital neurostimulation (tSNS) with the Cefaly® device in headache treatment: a survey of 2,313 headache sufferers in the general population.
MAGIS, Delphine ; SAVA, Simona Liliana ; et al
in Journal of Headache & Pain (2013), 14
BACKGROUND: Transcutaneous supraorbital nerve stimulation (tSNS) with the Cefaly® device was recently found superior to sham stimulation for episodic migraine prevention in a randomized trial. Its safety ... [more ▼]
BACKGROUND: Transcutaneous supraorbital nerve stimulation (tSNS) with the Cefaly® device was recently found superior to sham stimulation for episodic migraine prevention in a randomized trial. Its safety and efficiency in larger cohorts of headache sufferers in the general population remain to be determined.The objective of this study was to assess the satisfaction with the Cefaly® device in 2,313 headache sufferers who rented the device for a 40-day trial period via Internet. METHODS: Only subjects using specific anti-migraine drugs, and thus most likely suffering from migraine, were included in the survey. Adverse events (AEs) and willingness to continue tSNS were monitored via phone interviews after the trial period. A built-in software allowed monitoring the total duration of use and hence compliance in subjects who returned the device to the manufacturer after the trial period. RESULTS: After a testing period of 58.2 days on average, 46.6% of the 2,313 renters were not satisfied and returned the device, but the compliance check showed that they used it only for 48.6% of the recommended time. The remaining 54.4% of subjects were satisfied with the tSNS treatment and willing to purchase the device. Ninety-nine subjects out of the 2,313 (4.3%) reported one or more AEs, but none of them was serious. The most frequent AEs were local pain/intolerance to paresthesia (47 subjects, i.e. 2.03%), arousal changes (mostly sleepiness/fatigue, sometimes insomnia, 19 subjects, i.e. 0.82%), headache after the stimulation (12 subjects, i.e. 0.52%). A transient local skin allergy was seen in 2 subjects, i.e. 0.09%. CONCLUSIONS: This survey of 2,313 headache sufferers in the general population confirms that tSNS with is a safe and well-tolerated treatment for migraine headaches that provides satisfaction to a majority of patients who tested it for 40 days. Only 4.3% of subjects reported AEs, all of them were minor and fully reversible. [less ▲]Detailed reference viewed: 12 (0 ULg)
Neuromodulation of chronic headaches: position statement from the European Headache Federation
; ; et al
in Journal of Headache & Pain (2013), 14
The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side ... [more ▼]
The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even medically intractable. When a definitive lack of responsiveness to conservative treatments is ascertained and medication overuse headache is excluded, neuromodulation options can be considered in selected cases.Here, the various invasive and non-invasive approaches, such as hypothalamic deep brain stimulation, occipital nerve stimulation, stimulation of sphenopalatine ganglion, cervical spinal cord stimulation, vagus nerve stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and transcutaneous electrical nerve stimulation are extensively published although proper RCT-based evidence is limited. The European Headache Federation herewith provides a consensus statement on the clinical use of neuromodulation in headache, based on theoretical background, clinical data, and side effect of each method. This international consensus further gives recommendations for future studies on these new approaches.In spite of a growing field of stimulation devices in headaches treatment, further controlled studies to validate, strengthen and disseminate the use of neurostimulation are clearly warranted. Consequently, until these data are available any neurostimulation device should only be used in patients with medically intractable syndromes from tertiary headache centers either as part of a valid study or have shown to be effective in such controlled studies with an acceptable side effect profile. [less ▲]Detailed reference viewed: 9 (0 ULg)
Pearls and pitfalls: Electrophysiology for primary headaches
MAGIS, Delphine ; ; SAVA, Simona Liliana et al
in Cephalalgia : An International Journal of Headache (2013)Detailed reference viewed: 47 (5 ULg)
"Ceci n'est pas une migraine." Cas cliniques de céphalées de diagnostic difficile.
Conference (2013, April 11)Detailed reference viewed: 24 (6 ULg)
Transcranial Direct Current Stimulation (tDCS) of the visual cortex: a proof-of-concept study based on interictal electrophysiological abnormalities in migraine
; ; SAVA, Simona Liliana et al
in Journal of Headache & Pain (2013), 14(23),Detailed reference viewed: 55 (4 ULg)
Lateral inhibition in visual cortex of migraine patients between attacks
; ; et al
in Journal of Headache & Pain (2013), 14Detailed reference viewed: 24 (1 ULg)
Migraine prevention with a supraorbital transcutaneous stimulator. A randomized controlled trial.
Schoenen, Jean ; ; et al
in Neurology (2013), 80Detailed reference viewed: 95 (3 ULg)
Scientific advances in headache research: an update on neurostimulation
; MAGIS, Delphine
in Expert Review of Neurotherapeutics (2013), 13(1), 15-17Detailed reference viewed: 24 (1 ULg)
Transcutaneous Vagus Nerve Stimulation (tVNS) for headache prophylaxis: initial experience
MAGIS, Delphine ; GERARD, Pascale ; Schoenen, Jean
in Journal of Headache & Pain (2013)Detailed reference viewed: 16 (0 ULg)
High frequency headache prevalence and management in primary care. A survey among general practitioners of the Liege area, Belgium
MAGIS, Delphine ; Schoenen, Jean
in Journal of Headache & Pain (2013), 14Detailed reference viewed: 13 (0 ULg)
Quadripulse Repetitive Transcranial Magnetic Stimulation on Visual Cortex for Chronic Migraine Prevention: A Pilot-Trial
; ; et al
in Cephalalgia : An International Journal of Headache (2013), 33(8), 49Detailed reference viewed: 15 (1 ULg)