Combined transcranial and trans-spinal direct current stimulation in chronic headache: A feasibility and safety trial for a novel intervention

Background: Chronic primary headache disorders are associated with frequent, severe pain and significant functional impairment, with treatment remaining challenging. Objective: We examined the feasibility and safety of a novel brain [transcranial direct current stimulation (tDCS)] and spinal cord stimulation [trans-spinal cord direct current stimulation (tsDCS)] treatment in chronic headache. Methods: Nine participants (3 males; aged, 40 +/- 15 years) suffering from chronic daily headache, chronic tension-type headache, or chronic migraine received the combined brain and spinal cord intervention for 5 consecutive days. Stimulation was applied for a total of 40 minutes (20 minutes of tDCS followed by 20 minutes of tsDCS) at 1 mA. Pain sensitivity and headache symptoms (frequency, severity, duration, and medications recorded via a headache diary, 4 weeks before and after treatment) were assessed. Results: The treatment was safe, feasible, and well tolerated. Headache frequency was reduced following the treatment (p=0.026) in chronic tension-type headache and chronic migraine, but not in chronic daily headache. Headache severity was reduced immediately post-treatment in 67% of sessions. A trend towards a reduction in medication use was observed (p=0.075). No changes in headache severity (p=0.16) or duration (p=0.34) were present. Conclusion: These data suggest that combined tDCS and tsDCS intervention is safe and feasible, and may improve headache frequency in patients with chronic primary headache disorders. Copyright (C) 2017, Hong Kong Physiotherapy Association. Published by Elsevier (Singapore) Pte Ltd.