Estimulação transcraniana por corrente contínua associada à mindfulness na profilaxia da migrânea crônica

Abstract

Migraines are a type of sickness that is difficult to diagnose, whose symptoms affect the quality of life and the daily tasks of the affected person, resulting in momentary disability. Its pathophysiology is still imprecise, but the most accepted hypothesis is the neurological one explained by the dysfunction of the excitability of the cortical neurons - occurrence of a wave of occipital-frontal depolarization followed by a period of suppression of neuronal activity. The main treatment used is still pharmacological, but it can trigger a series of side effects that are difficult to tolerate, in addition to being unspecific. In this context, non-pharmacological therapies such as transcranial direct current stimulation (TDCS) and mindfulness have gained prominence for their low cost, safety and effectiveness. In view of the beneficial effects of combined mindfulness therapy and ETCC in disorders of the central nervous system, combined with the theoretical gap in clinical trials that investigate the use of these treatments in patients with migraines, we have chosen to divide this work into two chapters. The first chapter was dedicated to the scoping review of clinical trials aiming to compare the specific clinical results of ETCC of the main cortical targets used in migraines (primary motor - M1, primary visual - V1 and dorsolateral prefrontal - CPFDL). The analysis of the selected articles shows supremacy of the CPFDL stimulation points with regard to the decrease in pain intensity and V1 in terms of reducing the frequency of crises in this condition. The second chapter concerns the written article based on the randomized clinical trial (RCT) that we conducted associating ETCC with mindfulness in volunteers diagnosed with chronic migraine.. The objectives of this RCT were to assess whether such techniques were safe and effective when used together in patients with chronic migraines, to compare the degree of disability and the impact of headaches on activities in daily living, as well as the levels of mindfulness of the participants before and after the entire intervention was performed, in patients subdivided into groups of active ETCC and ETCC sham, both associated with mindfulness. After treatment, the active ETCC group combinated with the mindfulness showed better results in all outcomes. The sham group also combinated with the mindfulness showed improvements, but with smaller effect sizes compared to the active group. There was a significant difference in the analysis of interactions only in the case of post-treatment equivalent to the headache impact on the performance of daily activities, highlighting the active current group.