Migraine treatment with external trigeminal nerve stimulation: current knowledge on mechanisms
Available pharmacological migraine treatments have incomplete efficacy and many of them may have intolerable adverse effects. There is thus a need for alternative, more efficient and better tolerable therapies. Pericranial nerve stimulation methods represent such an alternative. Methods using implantable electrodes and stimulators can be used in the most severely disabled patients due their invasive nature and high adverse event rate. Thanks to technological advances, non-invasive, user-friendly, transcutaneous stimulators have been developed recently and are applicable also in less disabled patients. In particular, supraorbital external trigeminal nerve stimulation (eTNS) with the Cefaly ® device was found effective for migraine prevention in a randomized, sham-controlled trial, two open studies and one post-market survey. Non-controlled pilot studies and an Internet survey suggest that the device is also useful for migraine attack treatment; the results of a sham-controlled trial are about to be published.
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