What is the value of vagus nerve stimulation in migraine?

Chronic migraine headache prevention with noninvasive vagus nerve stimulation. The EVENT study

Silberstein SD, Calhoun AH, Lipton RB, et al; EVENT Study Group.

Neurology 2016; 87:529-538.

Abstract

OBJECTIVE:

To evaluate the feasibility, safety, and tolerability of noninvasive vagus nerve stimulation (nVNS) for the prevention of chronic migraine (CM) attacks.

METHODS:

In this first prospective, multicenter, double-blind, sham-controlled pilot study of nVNS in CM prophylaxis, adults with CM (≥15 headache d/mo) entered the baseline phase (1 month) and were subsequently randomized to nVNS or sham treatment (2 months) before receiving open-label nVNS treatment (6 months). The primary endpoints were safety and tolerability. Efficacy endpoints in the intent-to-treat population included change in the number of headache days per 28 days and acute medication use.

RESULTS:

Fifty-nine participants (mean age, 39.2 years; mean headache frequency, 21.5 d/mo) were enrolled. During the randomized phase, tolerability was similar for nVNS (n = 30) and sham treatment (n = 29). Most adverse events were mild/moderate and transient. Mean changes in the number of headache days were -1.4 (nVNS) and -0.2 (sham) (Δ = 1.2; p = 0.56). Twenty-seven participants completed the open-label phase. For the 15 completers initially assigned to nVNS, the mean change from baseline in headache days after 8 months of treatment was -7.9 (95% confidence interval -11.9 to -3.8; p < 0.01).

CONCLUSIONS:

Therapy with nVNS was well-tolerated with no safety issues. Persistent prophylactic use may reduce the number of headache days in chronic migraine; larger sham-controlled studies are needed.

You may also check out

Straube A, Ellrich J, Eren O, Blum B, Ruscheweyh R. Treatment of chronic migraine with transcutaneous stimulation of the auricular branch of the vagal nerve (auricular t-VNS): a randomized, monocentric clinical trial. J Headache Pain 2015; 16:543.

Both references are now included in the neurochecklist:

Migraine: interventional prophylaxis

screen-shot-2016-12-24-at-23-32-53

Abstract link

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CC BY-SA 3.0, Link
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