May A, Jürgens T P
Institut für Systemische Neurowissenschaften und Kopfschmerzambulanz der Neurologischen Klinik, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg.
Nervenarzt. 2011 Jun;82(6):743-52. doi: 10.1007/s00115-010-3170-x.
Neuromodulatory techniques have developed rapidly in the therapeutic management of refractory headaches. Invasive procedures comprise peripheral nerve stimulation (particularly occipital nerve stimulation), vagus nerve stimulation, cervical spinal cord stimulation and hypothalamic deep brain stimulation. Transcutaneous electrical nerve stimulation, repetitive transcranial magnetic stimulation and transcranial direct current stimulation are noninvasive variants. Based on current neuroimaging, neurophysiological and clinical studies occipital nerve stimulation and hypothalamic deep brain stimulation are recommended for patients with chronic cluster headache. Less convincing evidence can be found for their use in other refractory headaches such as chronic migraine. No clear recommendation can be given for the other neuromodulatory techniques. The emerging concept of intermittent stimulation of the sphenopalatine ganglion is nonetheless promising. Robust randomized and sham-controlled multicenter studies are needed before these therapeutic approaches are widely implemented. Due to the experimental nature all patients should be treated in clinical studies. It is essential to confirm the correct headache diagnosis and the refractory nature before an invasive approach is considered. Patients should generally be referred to specialized interdisciplinary outpatient departments which closely collaborate with neurosurgeons who are experienced in the implantation of neuromodulatory devices. It is crucial to ensure a competent postoperative follow-up with optimization of stimulation parameters and adjustment of medication.
神经调节技术在难治性头痛的治疗管理中发展迅速。侵入性手术包括周围神经刺激（特别是枕神经刺激）、迷走神经刺激、颈脊髓刺激和下丘脑深部脑刺激。经皮电神经刺激、重复经颅磁刺激和经颅直流电刺激是非侵入性的变体。基于目前的神经影像学、神经生理学和临床研究，枕神经刺激和下丘脑深部脑刺激推荐用于慢性丛集性头痛患者。在其他难治性头痛如慢性偏头痛中使用它们的证据不太令人信服。对于其他神经调节技术，无法给出明确的推荐。然而，蝶腭神经节间歇性刺激这一新兴概念很有前景。在这些治疗方法广泛应用之前，需要进行强有力的随机和假对照多中心研究。由于其实验性质，所有患者都应在临床研究中接受治疗。在考虑采用侵入性方法之前，确认正确的头痛诊断和难治性性质至关重要。患者通常应转诊至与植入神经调节装置经验丰富的神经外科医生密切合作的专业跨学科门诊。确保进行有效的术后随访，优化刺激参数并调整药物治疗至关重要。
