Transcranial Direct Current Stimulation of the Occipital Cortex in Medication Overuse Headache: A Pilot Randomized Controlled Cross-Over Study

Anthony G. Mansour^1,2,3,†,

Rechdi Ahdab^2,3,4,†,

Georges Khazen^2,5,

Christelle El-Khoury^2,6

Toni M. Sabbouh⁷,

Maher Salem²,

Wissam Yamak^2,3,4,

Moussa A. Chalah^8,9

Samar S. Ayache^8,9

and

Naji Riachi^2,4,*

Department of Internal Medicine, the Ohio State University, Columbus, OH 43210, USA

Gilbert and Rose Mary Chagoury School of Medicine School of Medicine, Lebanese American University, Byblos 4504, Lebanon

Division of Neurology, Hamidy Medical Center, Tripoli 1300, Lebanon

⁴

Division of Neurology, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon

⁵

Computer Science and Mathematics Department, Lebanese American University, Byblos 4504, Lebanon

⁶

Division of Family Medicine, Lebanese American University Medical Center, Beirut 113288, Lebanon

⁷

Department of Internal Medicine, Morristown Medical Center, Morristown, NJ 07960, USA

⁸

Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique- Hôpitaux de Paris, 94010 Créteil, France

⁹

EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

J. Clin. Med. 2020, 9(4), 1075; https://doi.org/10.3390/jcm9041075

Received: 2 March 2020 / Revised: 2 April 2020 / Accepted: 6 April 2020 / Published: 10 April 2020

(This article belongs to the Section Clinical Neurology)

Abstract

Background: Medication overuse headache (MOH) is a chronic pain syndrome that arises from the frequent use of acute antimigraine drugs. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique with a possible therapeutic effect in this particular context. Methods: This was a randomized, sham-controlled, cross-over study. Eighteen patients with MOH (17 women, age range: 20–38 years) received three sets of three consecutive daily sessions of tDCS: anodal tDCS over the prefrontal cortex, cathodal tDCS over the occipital cortex ipsilateral to the dominant side of migraine pain, and sham. The order in which the tDCS blocks were delivered was randomly defined based on a 1:1:1 ratio. Patients filled in a migraine diary that allowed recording of the pain intensity (visual analogue scale) and the daily consumption of analgesic pills from one week before to two weeks after each condition. Results: Both prefrontal and occipital tDCS lowered the total number of migraine days and the number of severe migraine days per week at week 1, but only the effects of occipital tDCS on these two outcomes lasted until week 2. Only occipital tDCS decreased the daily analgesic pills consumption, at weeks 1 and 2. Conclusion: Three consecutive days of cathodal occipital tDCS appear to improve the clinical outcomes in patients with MOH. View Full-Text

Keywords: cathodal occipital tDCS; anodal prefrontal tDCS; medication overuse headaches