Effectiveness of transcutaneous electrical nerve stimulation for the treatment of migraine: a meta-analysis of randomized controlled trials

Huimin Tao, Teng Wang, Xin Dong, Qi Guo, Huan Xu, Qi Wan, Huimin Tao, Teng Wang, Xin Dong, Qi Guo, Huan Xu, Qi Wan

Abstract

Background: Migraine is now ranked as the second most disabling disorder worldwide reported by the Global Burden of Disease Study 2016. As a noninvasive neurostimulation technique, transcutaneous electrical nerve stimulation(TENS) has been applied as an abortive and prophylactic treatment for migraine recently. We conduct this meta-analysis to analyze the effectiveness and safety of TENS on migraineurs.

Methods: We searched Medline (via PubMed), Embase, the Cochrane Library and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials, which compared the effect of TENS with sham TENS on migraineurs. Data were extracted and methodological quality assessed independently by two reviewers. Change in the number of monthly headache days, responder rate, painkiller intake, adverse events and satisfaction were extracted as outcome.

Results: Four studies were included in the quantitative analysis with 161 migraine patients in real TENS group and 115 in sham TENS group. We found significant reduction of monthly headache days (SMD: -0.48; 95% CI: -0.73 to - 0.23; P < 0.001) and painkiller intake (SMD: -0.78; 95% CI: -1.14 to - 0.42; P < 0.001). Responder rate (RR: 4.05; 95% CI: 2.06 to 7.97; P < 0.001) and satisfaction (RR: 1.85; 95% CI: 1.31 to 2,61; P < 0.001) were significantly increased compared with sham TENS.

Conclusion: This meta-analysis suggests that TENS may serve as an effective and well-tolerated alternative for migraineurs. However, low quality of evidence prevents us from reaching definitive conclusions. Future well-designed RCTs are necessary to confirm and update the findings of this analysis.

Systematic review registration: Our PROSPERO protocol registration number: CRD42018085984 . Registered 30 January 2018.

Keywords: Meta-analysis; Migraine; TENS; Transcutaneous electrical nerve stimulation.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

All authors have read and approved the manuscript for publication.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow diagram of studies. Process of identifying eligible studies for the meta-analysis
Fig. 2
Fig. 2
Risk of bias summery for included trials
Fig. 3
Fig. 3
Change in the number of monthly headache days. Forest plot of the meta-analysis showed a significant decrease in the number of monthly headache days after therapy with TENS compared with sham TENS
Fig. 4
Fig. 4
Change in the number of monthly headache days (sensitivity analysis). Sensitivity analysis showed that heterogeneity was most likely because of the study by Li et al., without which the heterogeneity reduced to zero with little change to the summary estimate
Fig. 5
Fig. 5
Responder rate. Forest plot of the meta-analysis showed significant increase in 50% responder rate after therapy with TENS compared with sham TENS
Fig. 6
Fig. 6
Painkiller intake. Forest plot of the meta-analysis showed a significant decrease in the number of painkiller intake after therapy with TENS compared with sham TENS
Fig. 7
Fig. 7
Satisfaction. Forest plot of the meta-analysis showed a significant increase in satisfaction after therapy with TENS compared with sham TENS
Fig. 8
Fig. 8
Quality of evidence assessment. Quality of evidence assessment for pain control outcomes performed by GRADE profiler

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