Combined transcranial and trans-spinal direct current stimulation in chronic headache: A feasibility and safety trial for a novel intervention.
Ghufran Alhassani, Julia Treleaven, Siobhan S M Schabrun
PMID 30931040WHAT IT FOUND
Five days of combined brain and spinal direct current stimulation was feasible and safe in nine chronic headache participants.
Headache frequency fell, but severity, duration and sensitivity to pressure did not change at follow-up.
Key findings
01Nine participants attended all five treatment sessions, and reported mild side effects such as tingling and itching that faded away.
02Headache frequency decreased after the 5-day intervention (p = 0.026), but headache severity and duration did not change at follow-up.
03Four weeks after stopping, 78% reported headache improvement, but sensitivity to mechanical stimuli did not change.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only nine participants were analysed, and the study was a pilot. The study was not designed or powered to determine the effect of treatment on clinical outcomes. There was no randomised control group, no sham stimulation and no blinding. All participants received both tDCS and tsDCS together, so the contribution of either component alone cannot be separated. Headache types varied, and the study was not powered to compare chronic tension-type headache, chronic migraine and chronic daily headache. Four participants withdrew before the treatment week, two withdrew after the first session, and one completed only three of five sessions.
Declared interests
The authors declared no relevant conflicts of interest. The work was supported by a Western Sydney University Seeding research grant, and the funding source had no involvement in the study.
The easy way to misread this
Do not conclude that combined brain and spinal direct current stimulation is an effective treatment for chronic headache. This was a small uncontrolled pilot with no sham, no randomised control group and no blinding, and follow-up severity, duration and mechanical sensitivity were unchanged.