Pulse focused ultrasound may provide an non-invasive, effective, longer lasting treatment for patients with chronic migraines and associated cutaneous allodynia, according to a study recently published in Brain Research.
Researchers studied the efficacy and safety of an external focused ultrasound device on animal models. At baseline, mobility and overall health were assessed, and then headaches were induced. The mean Von Frey filament thresholds were reduced in the periorbital from 8.43 ± 0.08 g to 7.22 ± 0.52 g and in the forepaw region from 14.35 ± 0.45 g to 12.72 ± 0.96 g, and the mechanical threshold was reduced significantly in both regions (P<.001 for both).
Inflammatory mediators decreased threshold further to 1.94 ± 0.42 g in the periorbital region and 8.43 ± 1.04 g in the forepaw region. After sumatriptan injections, the threshold significantly increased (P<.001) in the periorbital region on days 2-5. Ablative high intensity focused ultrasound treatment showed no significant differences on thresholds for the periorbital and forepaw regions. After pulsed focused ultrasound treatment, there was a significant increase in mechanical thresholds in the periorbital region 3 days post treatment. Occipital nerve and tissue processing signified no nuclear pyknosis of Schwann cells, widening of the subperineurial space, chromatolysis, vacuolization, or endoneurial/perineural edema 24 hours after pulsed focused ultrasound treatment. This indicates no damage to the occipital nerve components.
In conclusion, focused ultrasound on the occipital nerve significantly improved mechanical thresholds in animal models. This indicates a potential option of treatment for patients with chronic migraines and associated cutaneous allodynia.
Dr. Pilitsis is a consultant for Medtronic, Boston Scientific, Nevro, Jazz Pharmaceuticals, Neurobridge, Therapeutics, and Abbott and receives grant support from Medtronic, Boston Scientific, Abbott, Nevro, Jazz Pharmaceuticals, and NIH. She is a medical advisor for Centauri and Karuna and has stock equity.
Walling I, Panse D, Gee L, et al. The use of focused ultrasound for the treatment of cutaneous allodynia associated with chronic migraine [published online August 2, 2018]. Brain Res. doi: 10.1016/j.brainres.2018.08.004