Highlights
- •eTNS (Cefaly®) might relieve vertigo in acute vestibular migraine (VM).
- •eTNS might be a non-invasive, safe, drug-free potential rescue treatment for VM.
- •Trigemino-vestibular interconnections may explain how eTNS relieves VM.
Abstract
Objective
Vestibular migraine (VM) is the most common neurologic cause of vertigo among adults.
However, there are no specifically studied or approved rescue therapies for acute
VM attacks. This study describes how external trigeminal nerve stimulation (eTNS)
using the Cefaly® (CEFALY Technology, Seraing, Belgium) device relieves acute VM episodes.
Methods
Single-center, retrospective review of 19 patients with acute VM attacks (seen between
May 2018 and June 2019) treated with 20-min eTNS. Prior to treatment, patients graded
the severity of their vertigo/headache using a 10-point visual analog scale (VAS)
with 0 representing no vertigo/headache, and 10 representing the worst imaginable
vertigo/headache. After eTNS, patients graded their vertigo/headache using the same
VAS 15 min. In addition, bedside neuro-otologic examination was performed before and
after treatment.
Results
19/19 patients reported improvement in vertigo severity. Mean vertigo severity was
6.6 (±2.1; median 7) before eTNS, and 2.7 (±2.6; median 3) following treatment; mean
improvement in vertigo was 61.3% (±32.6; median 50.0%). During VM episodes, 14/19
experienced headache. Mean headache severity was 4.8 (±2.4; median 4.5) before eTNS,
and was 1.4 (±2.4; median 0) following treatment; mean improvement in headache was
77.2% (±32.7; median 100.0%). Neuro-otologic examination was normal during VM attacks
in all except Patient 7 who had spontaneous upbeat nystagmus which resolved after
eTNS. Other improvements include improvement of eye pressure, head pressure, and chronic
facial pain. No intolerable side effects were reported.
Conclusion
This study provides preliminary evidence that eTNS is a novel, non-invasive, safe
and effective treatment for acute VM attacks.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Vestibular migraine.Handb. Clin. Neurol. 2016; 137: 301-316
- Vestibular migraine: diagnostic criteria.J. Vestib. Res. 2012; 22: 167-172
- Vestibular migraine: how to sort it out and what to do about it.J. Neuroophthalmol. 2019; 39: 208-219
- Zolmitriptan for treatment of migrainous vertigo: a pilot randomized placebo-controlled trial.Neurology. 2003; 60: 882-883
- Migraine prevention with a supraorbital transcutaneous stimulator: a randomized controlled trial.Neurology. 2013; 80: 697-704
- Safety and patients’ satisfaction of transcutaneous supraorbital neurostimulation (tSNS) with the Cefaly® device in headache treatment: a survey of 2,313 headache sufferers in the general population.J Headache Pain. 2013; 14: 95
- Transcutaneous supraorbital neurostimulation for the prevention of chronic migraine: a prospective, open-label preliminary trial.Neurol. Sci. 2017; 38: 201-206
- Clinical experience with transcutaneous supraorbital nerve stimulation in patients with refractory migraine or with migraine and intolerance to topiramate: a prospective exploratory clinical study.BMC Neurol. 2017; 17: 97
- Transcutaneous supraorbital neurostimulation in “de novo” patients with migraine without aura: the first Italian experience.J Headache Pain. 2015; 16
- Schoenen J. a pilot study on supra-orbital surface electrotherapy in migraine.Cephalalgia. 2009; 29: 134
- Transcutaneous supraorbital nerve stimulation as a rescue therapy.Headache. 2014; 54: 12
- A survey on migraine attack treatment with the Cefaly® device in regular users.Acta Neurol. Belg. 2017; 117: 547-549
- External trigeminal nerve stimulation for the acute treatment of migraine: open-label trial on safety and efficacy.Neuromodulation. 2017; 20: 678-683
- Acute migraine therapy with external trigeminal neurostimulation (ACME): a randomized controlled trial.Cephalalgia. 2019; 39: 3-14
- Trancutaneous supraorbital nerve stimulation (t-SNS) with the Cefaly device for migraine prevention: a review of the available data.Pain Ther. 2015; 4: 135-147
- Rationale for electrical parameter determination in external trigeminal nerve stimulation for migraine: a narrative review.Cephalalgia. 2019; 39: 750-760
- Afferent connections to the sensory trigeminal nuclei, the nucleus of the solitary tract and adjacent structures.J. Comp. Neurol. 1956; 106: 51-141
- Fiber projections from the spinal trigeminal nucleus in the cat.J. Comp. Neurol. 1961; 117: 117-132
- Retrograde cellular changes in the mesencephalic trigeminal nucleus in the cat following cerebellar lesions.Acta Morphol Neer Scand. 1965; 19656: 147-159
- Trigemino-cerebellar fiber connections in the goat studied by means of the retrograde cell degeneration method.J. Comp. Neurol. 1968; 133: 71-88
- Projections from brainstem nuclei to the spinal trigeminal tractus in the cat.Neuroscience. 1983; 9: 411-420
- On the projections from the vestibular and perihypoglossal nuclei to the spinal trigeminal and lateral nuclei in the cat.Brain Res. 1985; 133: 123-130
- Central distribution of trigeminal and upper cervical primary afferents in the rats studied by anterograde transport of horseradish peroxidase conjugated to wheat germ-agglutinin.J. Comp. Neurol. 1988; 268: 91-108
- Trigeminal primary afferent projections to “non-trigeminal” areas of the rat central nervous system.J. Comp. Neurol. 1991; 196: 173-187
- Organisation of reciprocal connections between trigeminal and vestibular nuclei in the rat.J. Comp. Neurol. 1999; 409: 153-168
- Primary trigeminal afferents to the vestibular nuclei in the rat: existence of a collateral projection to the vestibulo-cerebellum.Neurosci. Lett. 1999; 264: 133-136
- Vestibulotrigeminal and vestibulospinal projections in rats: retrograde tracing coupled to glutamic acid decarboxylase immunoreactivity.Neurosci. Lett. 2003; 340: 225-228
- Vestibulotrigeminal pathways in the frog, Rana esculenta.Brain Res. Bull. 2008; 75: 371-374
- The interaction of the corneal reflex and vestibular nystagmus.Am. J. Phys. 1933; 103: 704-711
- Neuronal activity in vestibular nuclei after trigeminal stimulation.Exp. Neurol. 1981; 72: 12-24
- Responses to corneal stimulation in vestibulospinal units of nucleus deiters.Exp. Neurol. 1984; 83: 24-32
- Trigeminal stimulation elicits a peripheral vestibular imbalance in migraine patients.Headache. 2005; 45: 325-331
- Migraine and motion sickness: what is the link?.Prog. Neurobiol. 2010; 91: 300-312
- The role of vagal neurocircuits in the regulation of nausea and vomiting.Eur. J. Pharmacol. 2014; 722: 38-47
- The origin of nausea in migraine – a PET study.J Headache Pain. 2014; 15: 84
- Cerebral metabolism before and after external trigeminal nerve stimulation in episodic migraine.Cephalalgia. 2017; 37: 881-891
- The thalamocortical vestibular system in animals and humans.Brain Res. Rev. 2011; 67: 119-146
- Structure and function of the human insula.J. Clin. Neurophysiol. 2017; 34: 300-306
Article info
Publication history
Published online: October 25, 2019
Accepted:
October 21,
2019
Received in revised form:
October 19,
2019
Received:
August 7,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
