Anodal frontal tDCS for the treatment of refractory chronic cluster headache.
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1
Headache Research Unit. CHU de Liège, Belgium
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2
University of Liège, Belgium
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3
Hanyang University, Republic of Korea
Background:
Percutaneous occipital nerve stimulation (ONS) has proven effective for the treatment of refractory chronic cluster headache (rCCH) patients. ONS responders differ from non-responders by exhibiting a greater glucose metabolism in the subgenual region of the anterior cingulate cortex (sgACC). We hypothesized that anodal frontal transcranial direct current stimulation (tDCS) might be able to activate this area and thus improve symptomatology of rCCH patients.
Objective:
To explore the therapeutic potential of tDCS and its effects on pain perception, frontal executive functions and mood in rCCH patients.
Methods:
Following a 1-month baseline period, thirty-one patients were instructed to apply daily 20-min sessions of 2mA tDCS (anode at Fz, cathode over C7) for 4 or 8 weeks. Patients were provided paper diaries in order to monitor CH attacks. The primary outcome of this pilot study was the reduction in weekly cluster headache attacks between the baseline and the last week of tDCS. Data from 23 and 21 patients were available for a modified intention to treat and per-protocol analyses respectively. We also explored treatment-related modifications in thermal pain thresholds and nociceptive blink reflexes (nBR), as well as frontal lobe function and mood scales.
Results:
In the per-protocol analysis there was a mean 35% reduction in the attack frequency (p<0.001), with 41% of patients showing a decrease ≥50%. Attack intensity and duration were also significantly reduced. After 8 weeks (n=10), the 50% responder rate was 45%. Follow-up analyses (n=16) showed that two weeks after tDCS discontinuation the mean attack frequency rate returned to baseline levels. Amelioration was significant in patients with high baseline thermal pain thresholds in the forehead (n=12), but not in those with low thresholds (n=9). The Frontal Assessment Battery score improved after tDCS (p=0.01), while there was no change in depression scores or nBR.
Conclusion:
tDCS with a Fz-C7 montage may have a therapeutic effect in rCCH patients, especially those with low pain sensitivity, suggesting that a sham-controlled trial in cluster headache is worthwhile. Whether the effect is due to activation of the sgACC that can theoretically be reached by the electrical field here employed, or of other prefrontal cortical areas remains to be determined.
Acknowledgements
The authors wish to wholeheartedly acknowledge Dr. Anna Cosseddu for her help in data collection.
Keywords:
Chronic cluster headache,
transcranial direct current stimulation (tDCS),
anterior cingulate cortex (ACC),
Headache,
Pain
Conference:
Belgian Brain Congress 2018 — Belgian Brain Council, LIEGE, Belgium, 19 Oct - 19 Oct, 2018.
Presentation Type:
e-posters
Topic:
NOVEL STRATEGIES FOR NEUROLOGICAL AND MENTAL DISORDERS: SCIENTIFIC BASIS AND VALUE FOR PATIENT-CENTERED CARE
Citation:
Magis
D,
D’Ostilio
K,
Lisicki
M,
Lee
C and
Schoenen
J
(2019). Anodal frontal tDCS for the treatment of refractory chronic cluster headache..
Front. Neurosci.
Conference Abstract:
Belgian Brain Congress 2018 — Belgian Brain Council.
doi: 10.3389/conf.fnins.2018.95.00021
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Received:
30 Jul 2018;
Published Online:
17 Jan 2019.
*
Correspondence:
Dr. Delphine Magis, Headache Research Unit. CHU de Liège, Liège, Belgium, dmagis@chuliege.be