Migraine is a common, heterogeneous neurological disorder affecting approximately 10-15% of the global population and is the third most prevalent disease worldwide. A wide range of pharmacological agents is available for migraine prophylaxis, with treatment selection generally guided by the patient's clinical profile, associated comorbidities, and individual tolerability. However, the effectiveness of preventive medications is often limited by adverse effects, leading to poor treatment adherence and discontinuation. Consequently, non-pharmacological interventions, particularly neuromodulation techniques, have gained increasing attention as potential therapeutic options for chronic migraine.
Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique that has demonstrated efficacy in modulating refractory pain in patients with chronic migraine, fibromyalgia, spinal cord injury, and trigeminal neuralgia. In addition, it has shown therapeutic benefits in several neurological and psychiatric disorders, including depression, stroke, epilepsy, and Parkinson's disease. The present study aims to evaluate the efficacy of anodal tDCS applied over the primary motor cortex as an adjunctive therapy for reducing headache frequency in patients with chronic migraine.
A total of 32 participants with chronic migraine will be enrolled and randomized using block randomization with a block size of four, stratified according to the presence or absence of medication-overuse headache (MOH), through an online randomization generator. Participants will be allocated to receive either active or sham tDCS. Before randomization, all eligible patients will maintain a baseline headache diary for four weeks while continuing their existing prophylactic medications. Thereafter, they will undergo three 20-minute stimulation sessions administered during weeks 1, 5, and 9. Treatment outcomes will be evaluated at weeks 5, 9, and 12 using headache diary records and predefined objective assessment tools.
Patients aged 18-60 years diagnosed with chronic migraine as per ICHD-3.
Patients who were on a minimum of one concomitant preventive medication for not less than three months duration and a dose that was stable for at least one month prior to randomization.
Willingness to provide informed consent and maintain a headache diary.
Patients with neurologic diseases such as tumours, seizures, dementia, meningitis, stroke, etc.
Patients with barbiturate/opioid overuse or complications due to NSAID overuse.
Patients failing to complete headache diary for more than 6 non-consecutive days during baseline.
Illiterate patients without a caregiver to maintain the diary.
Parallel
Transcranial Direct Current stimulation
DevicePatients in group A will receive true anodal stimulation
Transcranial Direct Current stimulation
DevicePatients in group B will receive Sham stimulation
Change in frequency of moderate-severe headache days (week 12 vs baseline).
Change in the number of monthly moderate-to-severe headache days from baseline to Week 12, as recorded in the participant headache diary.
Change in migraine days (week 12 vs baseline).
Change in the frequency of monthly migraine days from baseline to Week 12, as recorded in the participant headache diary.
50% responder rate
The number of patients having a 50% reduction in migraine days per month in both groups was calculated at week 12
Change in headache severity (week 12 vs baseline).
The change in headache severity will be assessed at week 12 from baseline in terms of visual analogue score (0-3)
Change in number of days with acute medication use (week 12 vs baseline)
Change in the number of days requiring acute migraine medication use per month from baseline to Week 12, as recorded in the participant headache diary.
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