Introduction
With the technological advancements and booming, many novel curative modalities cropped up. These have expedited the treatment course as well as the recovery. Furthermore, technological ascent unraveled and streamlined many intricate remedial proceedings, rendering a promising way out for maladies or comorbidities. Technological booming, thereby, heightened and protracted its applicability in medical science.
What Are Neuromodulation Therapies?
Neuromodulation therapies embrace therapeutic strategies that temper and tune the nervous system. Neuronal functions are tempered to favor and support certain disease mitigation processes. It could also palliate the symptoms and manifestations concerning the illness. However, its therapeutic applicability is delimited to neurological illness.
The neuronal functional tempering can be carried on through discrete channels. Thermal, magnetic, or electrical triggers or stimulants can pull off neuromodulation. Strange and unintended nerve functioning can cause neurological illness. The malfunctioning neurons get adjusted and tuned by neuromodulation therapies. Though neuromodulation was conceptualized in the 1960s, it has confronted practical hardships that hold back its therapeutic employment. Neurological activities can be tuned up (upregulation) or tuned down (downregulation) through neuromodulation. Nevertheless, occasionally, it has been advocated for scaling down the neuronal response.
Recently, neuromodulation therapies have often been advocated for migraine (severe headache) patients, particularly in whom other conventional modalities fail. Likewise, certain patients may not tolerate the pill-based migraine intervention. Neuromodulation therapies are advocated in such patients as well.
What Is a Migraine?
Migraine is a customarily confronted episodic malady in which one may come up with intolerable and terrible episodic headaches. The pain will mostly be limited to within one-half of the head. A migraine is brought on by anomalous neuronal activities, prompting pain sensation. A typical migraine episode may linger for over four hours. Having said that, at times, the migraine episode may be drawn out for days, which could be bothersome and agonizing. The frequency and length of migraine varies with individuals. Apart from headaches, migraine may also cause:
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Vision problems (tunnel vision - dulling of side vision).
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Incapable of speaking fluently.
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Buzzing noise in the ear.
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Heavy extremities (legs and arms).
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Abnormal and altered sensations.
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Tendency to throw up (nausea).
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Sensitivity to light and noise.
Despite its manifestations, migraine patients may also experience certain pre-signs, called prodromal symptoms, ahead of the actual onset of migraine. Triptans, Dihydroergotamine, and antiemetics are the medicaments advocated to bring down a migraine episode. Furthermore, beta-blockers, tricyclic antidepressants, anticonvulsants, calcium channel blockers, and serotonin reuptake inhibitors have also been advocated to bring down upcoming migraine encounters.
How Do Neuromodulation Therapies Work for Migraine?
Neuromodulation therapies work by tuning the nerve functions. Migraine is instigated by aberrant nerve activities channeling pain signals. Through neuromodulation therapies, these anomalous pain signals are held off, which could effectively tone down the headache and other manifestations confronted with migraine. Neuromodulation therapies get a better hold of the abnormally regulated nerve activities by piloting the therapies on the appropriate brain segments that have caused migraine pain.
Magnetic, thermal, or electrical-based external interruptive signals tune the neuronal activities. These signals converse with the brain signals, cutting in and severing the signals that could bring about migraine pain. However, it does not undermine other neuronal functions. Those signals that could provoke and cause migraine are only modulated through neuromodulation, which underscores the targeted nature of these therapies.
Neuromodulation therapies are enforced through a specific neuromodulator device (stimulator). Some neuromodulator devices endorsed and sanctioned by the FDA (Food and Drug Administration) are:
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Single-pulse transcranial magnetic stimulators.
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Non-invasive vagus nerve stimulators.
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Supraorbital nerve stimulators.
It is through these devices that interruptive signals are channeled into the brain. These signals (magnetic or electric) interact and associate with the pain circuit, prompting structural and functional disparities in the neurotransmitters (chemical messengers). These neurotransmitters reinforce the brain’s ability to channel pain signals. Altered messenger molecules are unfit to expedite the signal conveyance process. Thus, the pain signals through which the migraine episodes are expressed get masked and muted.
Despite symptomatic mitigation of migraine, neuromodulation therapies could also turn down future migraine encounters. Neuromodulation therapies downgrade central sensitization. Central sensitization is liable for heightened neural activity towards pain. The proneness to pull off a migraine attack drops off by downgrading the central sensitization. This renders a preventative shielding for the person from upcoming migraine episodes.
What Are the Different Neuromodulation Therapies Employed for Migraines?
Various neuromodulation therapies have been advocated for migraine patients. Though all these therapies are grounded in the same core concept, they do differ in their action sites. Neuromodulation therapies encompass both non-invasive neuromodulation therapies and invasive or surgical neuromodulation therapies.
1. Non-invasive Neuromodulation Therapies: These are non-surgical maneuvers where the stimulator devices are stuck to specific locations. It is through these clamped devices that the modulatory signals are sent to appropriate action sites. Transcranial direct current stimulation, external trigeminal nerve stimulation, single-pulse transcranial magnetic stimulation, transcranial altering current stimulation, non-invasive vagus nerve stimulation, repetitive transcranial magnetic stimulation, and supraorbital transcutaneous nerve stimulation are part of the non-invasive neuromodulation therapies.
2. Invasive Neuromodulation Therapies: Invasive neuromodulation therapies, as the name states, call for a surgical approach. The so-called stimulator electrodes are to be embedded or engrafted into specific brain regions. Some invasive neuromodulation therapies include occipital nerve stimulation, vagal nerve stimulation, and deep brain stimulation. Invasive modalities are the least advocated, owing to surgical dangers. However, for refractory migraines (unresponsive to other modalities), invasive neuromodulation therapies could be advocated.
Reflecting on the patient's condition and migraine nature, the final say over the therapy choice is reserved with the doctors. Non-invasive neuromodulation therapies are customarily advocated due to their atraumatic nature, ease of procedure, and patient compliance. Various diseases and multiple medications delimit a full-fledged pharmacological migraine therapy. In such instances, neuromodulation therapies could render appreciable symptomatic mitigation.
Conclusion
Migraines, though a common occurrence, at times, do raise challenges in a sustainable recovery. Neuromodulation therapies are emerging as promising alternatives to be considered for migraine patients who have been living through this misery and distress. These therapies could jack up the quality of life of migraine sufferers. As an ongoing investigation, more data should be scrutinized concerning the neuromodulation therapies’ therapeutic applicability.
