Non-invasive Vagal Nerve Stimulation for the Treatment of Headache Attacks in Patients with Chronic Migraine and Medication-Overuse Headache (P1.262)

OBJECTIVE. To evaluate the safety and the efficacy of non-invasive vagal nerve stimulation (nVNS) for the treatment of headache attacks in patients with chronic migraine and medication overuse headache (CM/MOH) after a detoxification period. BACKGROUND. Approximately 20% of migraine patients develop CM/MOH. Medical treatment of CM/MOH patients is often challenging and neuromodulation is emerging as a new therapeutic option. Gammacore® is a portable non-invasive stimulator that produces a mild electrical signal transmitted to the vagus nerve through the skin. Preliminary reports suggested that migraine patients experience a reduction in the severity of their headache symptoms with nVNS. METHODS. Fifteen CM-MOH patients (1 man, 14 women; mean age ± SD = 49.9 ± 15.8 yrs) were enrolled in the study. Patients underwent a 5-day in-patient detoxification period and were then followed for a 6-month period. Headache attacks during the detoxification period and in the 6-month follow-up period were treated with repeated nVNS. The clinical characteristics of headaches were recorded in headache diaries. RESULTS. 362 migraine attacks were treated with nVNS during the study. At two-hours, a pain-free response was observed in 121/362 (33.4%). Average initial pain levels was 1.66 ± 0.7 and dropped to 1.1 ± 0.9 at two hours (p<0.001). A significant response to nVNS was observed in 50% of treated patients. Rescue medications were used in 67 (18.5%) of the attacks treated with Gammacore. Treatment related adverse events were frequent but mild. CONCLUSIONS. Our study shows that nVNS could be an efficient and safe treatment in patients with CM/MOH after detoxification. Additional studies in order to evaluate the long-term efficacy of this treatment are needed. Disclosure: Dr. Rainero has nothing to disclose. Dr. De Martino has nothing to disclose. Dr. Rubino has nothing to disclose. Dr. Vaula has nothing to disclose. Dr. Gentile has nothing to disclose. Dr. Pinessi has nothing to disclose.