Comparative Efficacy and Acceptability of Noninvasive Brain Stimulation for Migraine: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE

This network meta-analysis (NMA) aimed to compare and rank the efficacy and acceptability of different noninvasive brain stimulation (NIBS) techniques for migraine treatment in adults.

METHOD: We systematically searched PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov through October 13, 2025, for randomized controlled trials (RCTs) in adults with migraine. The primary outcomes were changes in monthly migraine days (MMD) and dropout rates, analyzed using a random-effects model. Heterogeneity was assessed with I2, risk of bias (RoB) with the Cochrane RoB 2 tool, and evidence quality with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.

RESULT: This NMA integrated data from 28 RCTs encompassing 1920 participants. Among the evaluated interventions, visual cortex (V1) transcranial direct current stimulation (tDCS) over Oz-Cz (VC-tDCS-OzCz)-an anodal protocol targeting the V1-ranked highest for reducing MMD (mean difference [MD] = -1.75; 95% CI: -3.37 to -0.13; surface under the cumulative ranking curve [SUCRA]: 83.5%). For acceptability, only transcutaneous occipital nerve stimulation (tONS) significantly reduced dropout rates versus sham (risk ratio [RR] = 0.36, 95% CI: 0.16-0.82).

CONCLUSION

Among the interventions evaluated, VC-tDCS-OzCz showed the largest reduction in MMD. However, these findings are based on predominantly moderate-to-low certainty evidence (GRADE), substantial heterogeneity, and a sparse network; they require confirmation in adequately powered, protocol-standardized trials.