The aim of this systematic review was to analyze the effectiveness and safety of the external trigeminal nerve stimulator (eTNS) for the prevention and acute treatment of migraine attacks in episodic and chronic migraine patients.
We have conducted a systematic literature search in four databases that yielded 433 citations and additional seven citations were found via hand-search. Two randomised placebo-controlled trials and five prospective case series were included in the analysis.
Concerning prevention, statistically significant differences were found with respect to reduction of migraine attacks (0.67 less migraine attacks per month), migraine days (1.74 less migraine days per month), headache days (2.28 less headache days per month), and acute antimigraine drug intake (4.24 less instances of acute drug intake per month). Concerning acute treatment, statistically significant differences were found with respect to pain reduction on a visual analogue scale at 1/2/24 h post-acute treatment (1.68/1.02/1.08 improvement, respectively). No serious adverse events occurred in any of the studies.
While e-TNS has the potential to improve migraine symptoms, for its establishment in the standard practice, high quality comparative data, studies with larger sample sizes, and studies with standard and relevant primary outcome parameters are needed.

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