Date of Award

2023

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not “Is transcutaneous supraorbital nerve stimulation (TSNS) effective for reducing the number of monthly migraine days in adults?”

STUDY DESIGN: A systematic review of three randomized controlled trials (RCTs) published between 2011 and 2021.

DATA SOURCES: All sources were obtained from PubMed, published in English in peer reviewed journals, and selected based on relevance to the clinical question.

OUTCOMES MEASURED: A reduction in the number of monthly migraine days was the outcome measured in all three studies and was determined by the mean change from baseline from run-in to the 3rd month of treatment based on participant migraine diaries.

RESULTS: The Schoenen et al. RCT resulted in a mean change from baseline of -2.06 days (95% CI: -0.54 to -3.58) in the TSNS group and -0.32 days (95% CI: 1.27 to -0.63) in the sham group. The results for TSNS were statistically significant (p = 0.023), however, statistical significance wasn’t achieved for the sham group (p = 0.608) or between groups (p = 0.054). The Deng et al. RCT resulted in a mean change from baseline of -3.50 days (95% CI: -0.74 to -4.74) in the TSNS group and -2.85 days (95% CI: -0.17 to -4.55) in the percutaneous mastoid electrical stimulator (PMES) group. The results were statistically significant in both the TSNS (p = 0.012) and PMES (p = 0.027) groups with comparable treatment effects between the groups (p = 0.88). The Jiang et al. RCT resulted in a mean change from baseline of -3.17  2.44 days in the TSNS + flunarizine group and -2.25  2.08 days in the flunarizine alone group. Results were statistically significant for both groups and between groups (p < 0.05).

CONCLUSIONS: TSNS is a safe, nonpharmacological intervention that is effective for reducing migraine days in adults. While all three studies demonstrated treatment with TSNS resulted in statistically significant reductions in migraine days, the Schoenen et al. study failed to reach a level of statistical significance when comparing the TSNS and sham groups.

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