Dalla Volta Giorgio, Marceglia Sara, Zavarise Paola, Antonaci Fabio
Brescia Headache Center, Istituto Clinico Città di Brescia, Brescia, Italy.
Dipartimento di Ingegneria e Architettura, Università degli Studi di Trieste, Trieste, Italy.
Front Neurol. 2020 Feb 21;11:121. doi: 10.3389/fneur.2020.00121. eCollection 2020.
To explore the efficacy of cathodal tDCS applied ipsilateral to the cold patch, as determined by thermographic evaluation, in the treatment of chronic migraine. Transcranial direct current stimulation (tDCS) is a non-invasive and safe technique that modulates the activity of the underlying cerebral cortex. tDCS has been extensively tested as a possible treatment for chronic pain and migraine with controversial results mainly due to the different setting procedure and location of electrodes. Since the presence of a hypothermic patch region detected through thermography has been suggested as a possible support for headache diagnosis, this "cold patch" could considered as possible effective location for tDCS application. Forty-five patients with chronic migraine were randomized to receive either cathodal (25 patients) or sham tDCS, for 5 consecutive daily sessions plus a recall session after 1 month. Cathodal tDCS was delivered at 1.5 mA for 15 min in each session. Subjects were evaluated before treatment (baseline, T0), and after 10 (T10), 60 (T60), and 120 (T120) days after treatment. The number of attacks, duration of attacks, pain intensity, number of days with headache, and number of analgesics were collected at each time evaluation. Patients in the tDCS group showed a significant improvement compared to the sham group, during the whole study period in the frequency of migraine attacks (tDCS vs. sham: -47.8 ± 50.1% vs. -14.2 ± 16.5%, = 0.004), number of days with headache (tDCS vs. sham: -42.7 ± 65.4% vs. -11.3 ± 18.0%, = 0.015), duration of attacks (tDCS vs. sham: -29.1 ± 43.4% vs. -7.5 ± 17.6%, = 0.016), intensity of the pain during an attack (tDCS vs. sham -31.1 ± 36.9% vs. 8.3 ± 13.5%, = 0.004), and number of analgesics (tDCS vs. sham -54.3 ± 37.4% vs. -16.0 ± 19.6%, < 0.0001). Our results suggest that cathodal tDCS is an effective adjuvant technique in migraine provided that an individual correct montage of the electrodes is applied, according to thermographic investigation.
通过热成像评估，探讨在冷贴片同侧施加阴极经颅直流电刺激（tDCS）治疗慢性偏头痛的疗效。经颅直流电刺激（tDCS）是一种无创且安全的技术，可调节大脑皮层下的活动。tDCS作为慢性疼痛和偏头痛的一种可能治疗方法已被广泛测试，但结果存在争议，主要是由于电极设置程序和位置不同。由于通过热成像检测到的低温贴片区域的存在被认为可能支持头痛诊断，这种“冷贴片”可被视为tDCS应用的可能有效部位。45例慢性偏头痛患者被随机分为接受阴极tDCS组（25例）或假tDCS组，连续每日治疗5次，并在1个月后进行回访。每次治疗时阴极tDCS以1.5 mA的电流持续15分钟。在治疗前（基线，T0）以及治疗后10天（T10）、60天（T60）和120天（T120）对受试者进行评估。在每次评估时收集发作次数、发作持续时间、疼痛强度、头痛天数和镇痛药使用数量。在整个研究期间，tDCS组患者在偏头痛发作频率（tDCS组与假刺激组：-47.8±50.1% vs. -14.2±16.5%，P = 0.004）、头痛天数（tDCS组与假刺激组：-42.7±65.4% vs. -11.3±18.0%，P = 0.015）、发作持续时间（tDCS组与假刺激组：-29.1±43.4% vs. -7.5±17.6%，P = 0.016）、发作时疼痛强度（tDCS组与假刺激组：-31.1±36.9% vs. 8.3±13.5%，P = 0.004）以及镇痛药使用数量（tDCS组与假刺激组：-54.3±37.4% vs. -16.0±19.6%，P < 0.0001）方面，与假刺激组相比均有显著改善。我们的结果表明，根据热成像检查，只要正确应用个体化的电极配置，阴极tDCS是偏头痛治疗中的一种有效辅助技术。
