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Non-invasive Nerve Stimulation Modalities for Migraine Pain: A Review of Clinical Effectiveness and Cost-effectiveness

Last updated: April 27, 2020
Project Number: RC1265-000
Product Line: Rapid Response
Research Type: Device
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of non-invasive nerve stimulation modalities for adult patients with migraine pain?
  2. What is the cost-effectiveness of non-invasive nerve stimulation modalities for adult patients with migraine pain?

Key Message

This report included two health technology assessments (HTAs) and two systematic reviews (SRs) that identified one unique primary study, in addition to two randomized controlled trials (RCTs) regarding the clinical effectiveness of various non -invasive nerve simulation (NINS) modalities for the treatment of migraine pain. However, of the included HTAs and SRs, only one of the SRs included a relevant primary study.

There is a lack of evidence on the effectiveness of NINS modalities compared to standard of care. The limited comparative clinical evidence suggests that migraine prophylaxis with NINS devices such as transcutaneous Supraorbital Neurostimulation (tSNS), transcutaneous Occipital Nerve Stimulation (tONS) and repetitive Transcranial Magnetic Stimulation (rTMS) were not different compared to standard of care (pharmacological and non-pharmacological interventions) in improving clinical symptoms. However, the findings should be interpreted with caution, in light of the limited available evidence and the quality and generalizability of included studies.  The modalities were found to be effective in improving symptoms and safe with few adverse events. No evidence was found for the clinical effectiveness of NINS devices in abortive treatments of acute migraine attacks. No evidence regarding the cost effectiveness of NINS devices compared to standard of care were identified. No evidence on the clinical and cost effectiveness of other available NINS devices were found.