Exploring the Use of Vagal Nerve Stimulation as an Alternative to Commonly Prescribed Migraine Medicine

Authors

  • Dhruv Veda Centennial High School

DOI:

https://doi.org/10.47611/jsrhs.v12i3.4508

Keywords:

Migraine, VNS, neurology, headache, neuromodulation, pain, pain management, triptan, ergotamine, review, electrode, auricular

Abstract

Scholars often define migraine as a headache of varying intensity, often accompanied by nausea, sensitivity to light, and sound (Pescador et al., 2022; Yeh et al., 2018; Weatherall et al., 2015). Migraine is a debilitating disease that affects a sizable portion of humans. Currently, the most common method of treatment for migraines is mediation from drugs such as Ergotamines and Triptans. Although medication is a very common treatment, many alternative treatments exist. Although such medications have varying degrees of effectiveness, they  are becoming increasingly common, in part, due to their cost effectiveness and simplicity of use. The purpose of the current work is to summarize the research done on one particularly promising alternative method, namely vagal nerve stimulation (VNS) and propose avenues for further research. VNS comes in multiple forms (auricular, cervical, inserted), each of which are associated with differential levels of effectiveness in reducing migraine symptomatology. Importantly, each form of VNS is also associated with distinct drawbacks as well. The current work suggests that more research is still needed to robustly understand the optimal method of VNS for migraine treatment and how VNS interacts with other treatments  (e.g., medication). In addressing these topics, the current work seeks to construct a more robust understanding of the promise and future applications of VNS. 

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References or Bibliography

Becerra L, Bishop J, Barmettler G, Xie Y, Navratilova E, Porreca F, Borsook D. Triptans disrupt brain networks and promote stress-induced CSD-like responses in cortical and subcortical areas. J Neurophysiol. 2016 Jan 1;115(1):208-17. doi: 10.1152/jn.00632.2015. Epub 2015 Oct 21. PMID: 26490291; PMCID: PMC4760506.

Booth, S(2022, August 22). How Migraine Prevention Treatments Work, WebMD https://www.webmd.com/migraines-headaches/migraine-prevention-meds-explained

Cameron C, Kelly S, Hsieh SC, Murphy M, Chen L, Kotb A, Peterson J, Coyle D, Skidmore B, Gomes T, Clifford T, Wells G. Triptans in the Acute Treatment of Migraine: A Systematic Review and Network Meta-Analysis. Headache. 2015 Jul-Aug;55 Suppl 4:221-35. doi: 10.1111/head.12601. Epub 2015 Jul 14. PMID: 26178694.

Dieterich M, Obermann M, Celebisoy N. Vestibular migraine: the most frequent entity of episodic vertigo. J Neurol. 2016 Apr;263 Suppl 1:S82-9. doi: 10.1007/s00415-015-7905-2. Epub 2016 Apr 15. PMID: 27083888; PMCID: PMC4833782.

Figure 1. CGRP action at peripheral receptors [Graph illustration]. Adapted from Russo, A. (2010). Journal of Neurochemistry, 112(5), 1165-1179. https://doi.org/10.1111/j.1471-4159.2009.06560.x

Figure 2. Trigeminal nerve distribution with TCN, vagus, and spinal accessory nerves [Illustration]. Retrieved from https://centennialfamilychiro.com/wp-content/uploads/2020/03/Trigeminal-nerve-distribution-with-TCN-vagus-and-spinal-accesary.png

Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiol Rev. 2017 Apr;97(2):553-622. doi: 10.1152/physrev.00034.2015. PMID: 28179394; PMCID: PMC5539409.

Hearing Aids.(2022, October 11). National Institute of Health https://www.nidcd.nih.gov/health/over-counter-hearing-aids

Hoffmann J, Recober A. Migraine and triggers: post hoc ergo propter hoc? Curr Pain Headache Rep. 2013 Oct;17(10):370. doi: 10.1007/s11916-013-0370-7. PMID: 23996725; PMCID: PMC3857910.

Hou M, Liu H, Li Y, Xu L, He Y, Lv Y, Zheng Q, Li L. Efficacy of triptans for the treatment of acute migraines: a quantitative comparison based on the dose-effect and time-course characteristics. Eur J Clin Pharmacol. 2019 Oct;75(10):1369-1378. doi: 10.1007/s00228-019-02748-4. Epub 2019 Aug 24. PMID: 31446449.

How gammaCore Works.(2022, March 22). gammaCore https://www.gammacore.com/about/how-gammacore-works/

Kamin D.(2019, April 25).OTC:Wrapping your mind around migraine medication. UC san diego health https://health.ucsd.edu/care/neurological/headache/

Krahl SE, Clark KB. Vagus nerve stimulation for epilepsy: A review of central mechanisms. Surg Neurol Int. 2012;3(Suppl 4):S255-9. doi: 10.4103/2152-7806.103015. Epub 2012 Oct 31. PMID: 23230530; PMCID: PMC3514919.

Leroux, E., Buchanan, A., Lombard, L. et al. Evaluation of Patients with Insufficient Efficacy and/or Tolerability to Triptans for the Acute Treatment of Migraine: A Systematic Literature Review. Adv Ther 37, 4765–4796 (2020). https://doi.org/10.1007/s12325-020-01494-9

Magis D, Gerard P, Schoenen (2012, September 23) Transcutaneous Vagus Nerve Stimulation (tVNS) for headache prophylaxis: initial experience doi:10.1186/1129-2377-14-S1-P198

Mason B, R Andrew. Vascular Contributions to Migraine: Time to Revisit? Effects. Frontiers 2018 AUG. doi:10.3389/fncel.2018.00233

meta-analysis. Cephalalgia. 2014 Apr;34(4):258-67. doi: 10.1177/0333102413508661. Epub 2013 Oct 9. PMID: 24108308.

Metcalf E.(2022, August 31). Ocular Migraines. WebMD https://www.webmd.com/migraines-headaches/ocular-migraine-basics

Migraine - Treatment - NHS.(2019, May 10) National Health Service https://www.nhs.uk/conditions/migraine/treatment/

Morris J, Straube A, Diener H, Ahmed F, Silver N, Walker S, Libler E, et al.(2016) Cost-effectiveness analysis of non-invasive vagus nerve stimulation for the treatment of chronic cluster headache. doi: 10.1186/s10194-016-0633-x

Mosqueira AJ, López-Manzanares L, Canneti B, Barroso A, García-Navarrete E, Valdivia A, Vivancos J. Estimulacion del nervio vago en pacientes migrañosos [Vagus nerve stimulation in patients with migraine]. Rev Neurol. 2013 Jul 16;57(2):57-63. Spanish. PMID: 23836335.https://pubmed.ncbi.nlm.nih.gov/23836335/

Najib U, Smith T, Hindiyeh N, Saper J, Nye B, Ashina S, McClure C, et al.(2021, December 7) Non-invasive vagus nerve stimulation for prevention of migraine: The multicenter, randomized, double-blind, sham-controlled PREMIUM II trial doi:10.1177/03331024211068813

O'Connell S, Dale M, Morgan H, Carter K, Morris R, Carolan-Rees G. gammaCore for Cluster Headaches: A NICE Medical Technologies Guidance. Pharmacoecon Open. 2021 Dec;5(4):577-586. doi: 10.1007/s41669-021-00276-5. Epub 2021 Jul 28. PMID: 34322861; PMCID: PMC8611122.

Pescador Ruschel MA, De Jesus O. Migraine Headache. [Updated 2022 Nov 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560787/

Peterlin BL, Gupta S, Ward TN, Macgregor A. Sex matters: evaluating sex and gender in migraine and headache research. Headache. 2011 Jun;51(6):839-42. doi: 10.1111/j.1526-4610.2011.01900.x. PMID: 21631471; PMCID: PMC3975603.

Roberto G, Raschi E, Piccinni C, Conti V, Vignatelli L, D'Alessandro R, De Ponti F, Poluzzi E. Adverse cardiovascular events associated with triptans and ergotamines for treatment of migraine: systematic review of observational studies. Cephalalgia. 2015 Feb;35(2):118-31. doi: 10.1177/0333102414550416. Epub 2014 Sep 22. PMID: 25246519.

Rudolf K, Eberlein W, Engel W, Pieper H, Entzeroth M, Hallermayer G, Doods H. Development of human calcitonin gene-related peptide (CGRP) receptor antagonists. 1. Potent and selective small molecule CGRP antagonists. 1-[N2-[3,5-dibromo-N-[[4-(3,4-dihydro-2(1H)-oxoquinazolin-3-yl)-1-piperidinyl]carbonyl]-D-tyrosyl]-l-lysyl]-4-(4-pyridinyl)piperazine: the first CGRP antagonist for clinical trials in acute migraine. J Med Chem. 2005 Sep 22;48(19):5921-31. doi: 10.1021/jm0490641. PMID: 16161996.

Russell FA, King R, Smillie SJ, Kodji X, Brain SD. Calcitonin gene-related peptide: physiology and pathophysiology. Physiol Rev. 2014 Oct;94(4):1099-142. doi: 10.1152/physrev.00034.2013. PMID: 25287861; PMCID: PMC4187032.

Schwedt J, Garza I. (2022, May 10)Acute treatment of migraine in adults. Up To Date https://www.uptodate.com/contents/acute-treatment-of-migraine-in-adults

Silberstein SD, Calhoun AH, Lipton RB, Grosberg BM, Cady RK, Dorlas S, Simmons KA, Mullin C, Liebler EJ, Goadsby PJ, Saper JR; EVENT Study Group. Chronic migraine headache prevention with noninvasive vagus nerve stimulation: The EVENT study. Neurology. 2016 Aug 2;87(5):529-38. doi: 10.1212/WNL.0000000000002918. Epub 2016 Jul 13. PMID: 27412146; PMCID: PMC4970666.

Straube A, Ellrich J, Eren O, Blum B, Ruschwey R(2015) Treatment of chronic migraine with transcutaneous stimulation of the auricular branch of the vagal nerve (auricular t-VNS): a randomized, monocentric clinical trial.

Takahashi, T.T., Ornello, R., Quatrosi, G. et al. Medication overuse and drug addiction: a narrative review from addiction perspective. J Headache Pain 22, 32 (2021). https://doi.org/10.1186/s10194-021-01224-8

Thorlund K, Mills EJ, Wu P, Ramos E, Chatterjee A, Druyts E, Goadsby PJ. Comparative efficacy of triptans for the abortive treatment of migraine: a multiple treatment comparison https://pubmed.ncbi.nlm.nih.gov/24108308/

Vagus nerve stimulation(2022, September 14). Mayo Clinic https://www.mayoclinic.org/tests-procedures/vagus-nerve-stimulation/about/pac-20384565

Vagus Nerve Stimulation(VNS) Implementation for Children(2022) UPMC children's hospital https://www.chp.edu/our-services/brain/neurology/epilepsy/treatment

Verma N, Mudge J, Kasole M, Chen R, Blanz S, Trevathan J, Lovett J, Williams J, Ludwig K. Auricular Vagus Neuromodulation - A systematic Review on Quality of Evidence and Clinical Effects. Frontiers 2021 Apr. doi:10.3389/fnins.2021.664740

Weatherall MW. The diagnosis and treatment of chronic migraine. Ther Adv Chronic Dis. 2015 May;6(3):115-23. doi: 10.1177/2040622315579627. PMID: 25954496; PMCID: PMC4416971.

Yang C, Liang C, Chang C, et al. Comparison of New Pharmacologic Agents With Triptans for Treatment of Migraine: A Systematic Review and Meta-analysis. JAMA Netw Open. 2021;4(10):e2128544. doi:10.1001/jamanetworkopen.2021.28544

Yeh WZ, Blizzard L, Taylor BV. What is the actual prevalence of migraine? Brain Behav. 2018 Jun;8(6):e00950. doi: 10.1002/brb3.950. Epub 2018 May 2. PMID: 30106228; PMCID: PMC5991594.

Zhang Y, Liu J, Li H, Yan Z, Liu X, Cao J, Park J, et al.(2019)Transcutaneous auricular vagus nerve stimulation at 1 Hz modulates locus coeruleus activity and resting state functional connectivity in patients with migraine: An fMRI study. doi:10.1016/j.nicl.2019.101971

Published

08-31-2023

How to Cite

Veda, D. (2023). Exploring the Use of Vagal Nerve Stimulation as an Alternative to Commonly Prescribed Migraine Medicine. Journal of Student Research, 12(3). https://doi.org/10.47611/jsrhs.v12i3.4508

Issue

Section

HS Review Articles