Introduction: Available preventive drug treatments for migraine lack complete efficacy and often have unpleasant adverse effects. Hence, their clinical utility and therapeutic adherence are limited. Noninvasive neurostimulation methods applied over various peripheral sites (forehead, mastoid, upper arm, cervical vagus nerve) have raised great interest because of their excellent efficacy/tolerance profile. Among them external trigeminal nerve stimulation (eTNS) was first to obtain FDA approval for migraine therapy. Areas covered: All clinical trials of eTNS as preventive or acute migraine treatment published in extenso or presented at congresses are reviewed. The paper analyzes neuroimaging and neurophysiological studies on mechanisms of action of eTNS. As many of these studies point toward the anterior cingulate cortex (ACC) as a likely eTNS target, the paper scrutinizes the available literature on the ACC implication in migraine pathophysiology. Expert commentary: eTNS is a viable alternative to standard pharmacological antimigraine strategies both for prevention and abortive therapy. eTNS could chiefly exert its action by modulating the perigenual ACC, which might also be of interest for treating other disorders like fibromyalgia or depression. It remains to be determined if this might be a common mechanism to other peripheral noninvasive neurostimulation methods.

Efficacy and mode of action of external trigeminal neurostimulation in migraine / Schoenen, Jean; Coppola, Gianluca. - In: EXPERT REVIEW OF NEUROTHERAPEUTICS. - ISSN 1473-7175. - STAMPA. - 18:7(2018), pp. 545-555. [10.1080/14737175.2018.1488588]

Efficacy and mode of action of external trigeminal neurostimulation in migraine

Coppola, Gianluca
2018

Abstract

Introduction: Available preventive drug treatments for migraine lack complete efficacy and often have unpleasant adverse effects. Hence, their clinical utility and therapeutic adherence are limited. Noninvasive neurostimulation methods applied over various peripheral sites (forehead, mastoid, upper arm, cervical vagus nerve) have raised great interest because of their excellent efficacy/tolerance profile. Among them external trigeminal nerve stimulation (eTNS) was first to obtain FDA approval for migraine therapy. Areas covered: All clinical trials of eTNS as preventive or acute migraine treatment published in extenso or presented at congresses are reviewed. The paper analyzes neuroimaging and neurophysiological studies on mechanisms of action of eTNS. As many of these studies point toward the anterior cingulate cortex (ACC) as a likely eTNS target, the paper scrutinizes the available literature on the ACC implication in migraine pathophysiology. Expert commentary: eTNS is a viable alternative to standard pharmacological antimigraine strategies both for prevention and abortive therapy. eTNS could chiefly exert its action by modulating the perigenual ACC, which might also be of interest for treating other disorders like fibromyalgia or depression. It remains to be determined if this might be a common mechanism to other peripheral noninvasive neurostimulation methods.
2018
antimigraine treatment; external trigeminal nerve stimulation; noninvasive neurostimulation; perigenual anterior cingulate cortex; neuroscience (all); neurology (clinical); pharmacology (medical)
01 Pubblicazione su rivista::01a Articolo in rivista
Efficacy and mode of action of external trigeminal neurostimulation in migraine / Schoenen, Jean; Coppola, Gianluca. - In: EXPERT REVIEW OF NEUROTHERAPEUTICS. - ISSN 1473-7175. - STAMPA. - 18:7(2018), pp. 545-555. [10.1080/14737175.2018.1488588]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1144415
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