Neuromodulation in Chronic Migraine: Evidence and Recommendations from the GRADE Framework

Area of Science:

• Neurology
• Pain Management
• Medical Technology

Background:

• Chronic migraine (CM) impacts 2% of the population, often resistant to standard treatments.
• CM significantly impairs daily function, productivity, and incurs substantial costs.
• Pain modulation is key to improving quality of life for CM patients.

Purpose of the Study:

• To review the evidence and assess the strength of recommendations for neuromodulation in CM.
• To evaluate therapeutic risk/benefit, costs, resource use, and patient/clinician preferences for neuromodulation.

Main Methods:

• Systematic review of emerging neuromodulation techniques for CM.
• Assessment of study evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.
• Evaluation of non-invasive (VNS, TMS, REM) and invasive (DBS, ONS, HF-10 SNS) methods.

Main Results:

• Neuromodulation for CM is gaining attention, with promising early trial outcomes for various techniques.
• Established invasive methods like nerve neurolysis have high complication rates and are not recommended.
• No consensus exists on the effectiveness and safety of current neuromodulation procedures for CM.

Conclusions:

• Emerging neuromodulation techniques show potential for chronic migraine management.
• Further research and consensus are needed before widespread clinical adoption of these therapies.
• Consideration of risk/benefit, cost, and patient preferences is crucial for neuromodulation implementation.