Get access

tDCS-Induced Analgesia and Electrical Fields in Pain-Related Neural Networks in Chronic Migraine

Authors

  • Alexandre F. DaSilva DDS, DMedSc,

    1. From the Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA (A.F. DaSilva and M.F. DosSantos); Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA (M.E. Mendonca, S. Zaghi, A. Datta, and F. Fregni); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital & Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.E. Mendonca and F. Fregni); Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (S. Zaghi, M. Lopes, and F. Fregni); Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (E.L. Spierings); Arnold Pain Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (Z. Bajwa); Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, USA (M. Bikson).
    Search for more papers by this author
    • Equally contributing authors.

  • Mariana E. Mendonca PT,

    1. From the Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA (A.F. DaSilva and M.F. DosSantos); Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA (M.E. Mendonca, S. Zaghi, A. Datta, and F. Fregni); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital & Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.E. Mendonca and F. Fregni); Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (S. Zaghi, M. Lopes, and F. Fregni); Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (E.L. Spierings); Arnold Pain Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (Z. Bajwa); Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, USA (M. Bikson).
    Search for more papers by this author
    • Equally contributing authors.

  • Soroush Zaghi MD,

    1. From the Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA (A.F. DaSilva and M.F. DosSantos); Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA (M.E. Mendonca, S. Zaghi, A. Datta, and F. Fregni); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital & Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.E. Mendonca and F. Fregni); Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (S. Zaghi, M. Lopes, and F. Fregni); Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (E.L. Spierings); Arnold Pain Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (Z. Bajwa); Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, USA (M. Bikson).
    Search for more papers by this author
  • Mariana Lopes MD,

    1. From the Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA (A.F. DaSilva and M.F. DosSantos); Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA (M.E. Mendonca, S. Zaghi, A. Datta, and F. Fregni); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital & Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.E. Mendonca and F. Fregni); Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (S. Zaghi, M. Lopes, and F. Fregni); Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (E.L. Spierings); Arnold Pain Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (Z. Bajwa); Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, USA (M. Bikson).
    Search for more papers by this author
  • Marcos Fabio DosSantos DDS, MS,

    1. From the Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA (A.F. DaSilva and M.F. DosSantos); Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA (M.E. Mendonca, S. Zaghi, A. Datta, and F. Fregni); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital & Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.E. Mendonca and F. Fregni); Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (S. Zaghi, M. Lopes, and F. Fregni); Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (E.L. Spierings); Arnold Pain Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (Z. Bajwa); Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, USA (M. Bikson).
    Search for more papers by this author
  • Egilius L. Spierings MD, PhD,

    1. From the Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA (A.F. DaSilva and M.F. DosSantos); Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA (M.E. Mendonca, S. Zaghi, A. Datta, and F. Fregni); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital & Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.E. Mendonca and F. Fregni); Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (S. Zaghi, M. Lopes, and F. Fregni); Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (E.L. Spierings); Arnold Pain Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (Z. Bajwa); Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, USA (M. Bikson).
    Search for more papers by this author
  • Zahid Bajwa MD,

    1. From the Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA (A.F. DaSilva and M.F. DosSantos); Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA (M.E. Mendonca, S. Zaghi, A. Datta, and F. Fregni); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital & Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.E. Mendonca and F. Fregni); Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (S. Zaghi, M. Lopes, and F. Fregni); Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (E.L. Spierings); Arnold Pain Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (Z. Bajwa); Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, USA (M. Bikson).
    Search for more papers by this author
  • Abhishek Datta PhD,

    1. From the Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA (A.F. DaSilva and M.F. DosSantos); Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA (M.E. Mendonca, S. Zaghi, A. Datta, and F. Fregni); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital & Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.E. Mendonca and F. Fregni); Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (S. Zaghi, M. Lopes, and F. Fregni); Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (E.L. Spierings); Arnold Pain Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (Z. Bajwa); Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, USA (M. Bikson).
    Search for more papers by this author
  • Marom Bikson PhD,

    1. From the Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA (A.F. DaSilva and M.F. DosSantos); Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA (M.E. Mendonca, S. Zaghi, A. Datta, and F. Fregni); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital & Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.E. Mendonca and F. Fregni); Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (S. Zaghi, M. Lopes, and F. Fregni); Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (E.L. Spierings); Arnold Pain Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (Z. Bajwa); Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, USA (M. Bikson).
    Search for more papers by this author
  • Felipe Fregni MD, PhD

    Corresponding author
    1. From the Headache & Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA (A.F. DaSilva and M.F. DosSantos); Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA (M.E. Mendonca, S. Zaghi, A. Datta, and F. Fregni); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital & Massachusetts General Hospital, Harvard Medical School, Boston, MA (M.E. Mendonca and F. Fregni); Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (S. Zaghi, M. Lopes, and F. Fregni); Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (E.L. Spierings); Arnold Pain Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA (Z. Bajwa); Department of Biomedical Engineering, The City College of the City University of New York, New York, NY, USA (M. Bikson).
    Search for more papers by this author

  • Conflict of interest: The City University of New York has intellectual property on brain stimulation with Marom Bikson and Abhishek Datta as inventors.

F. Fregni, Laboratory of Neuromodulation, 125 Nashua Street #727, Boston, MA 02114, USA, email: fregni.felipe@mgh.harvard.edu

Abstract

Objective.— We investigated in a sham-controlled trial the analgesic effects of a 4-week treatment of transcranial direct current stimulation (tDCS) over the primary motor cortex in chronic migraine. In addition, using a high-resolution tDCS computational model, we analyzed the current flow (electric field) through brain regions associated with pain perception and modulation.

Methods.— Thirteen patients with chronic migraine were randomized to receive 10 sessions of active or sham tDCS for 20 minutes with 2 mA over 4 weeks. Data were collected during baseline, treatment and follow-up. For the tDCS computational analysis, we adapted a high-resolution individualized model incorporating accurate segmentation of cortical and subcortical structures of interest.

Results.— There was a significant interaction term (time vs group) for the main outcome (pain intensity) and for the length of migraine episodes (ANOVA, P < .05 for both analyses). Post-hoc analysis showed a significant improvement in the follow-up period for the active tDCS group only. Our computational modeling studies predicted electric current flow in multiple cortical and subcortical regions associated with migraine pathophysiology. Significant electric fields were generated, not only in targeted cortical regions but also in the insula, cingulate cortex, thalamus, and brainstem regions.

Conclusions.— Our findings give preliminary evidence that patients with chronic migraine have a positive, but delayed, response to anodal tDCS of the primary motor cortex. These effects may be related to electrical currents induced in pain-related cortical and subcortical regions.

Ancillary