Notaro Paolo, Buratti Elisa, Meroni Adriano, Montagna Maria Cesarina, Rubino Fabio Gerardo, Voltolini Alessandra
Pain Medicine, Anesthesiology Department, A.O. Ospedale Niguarda ca Granda, Milano, Italy.
Pain Physician. 2014 May-Jun;17(3):E369-74.
About 1% of patients suffering from chronic migraine do not respond to medications and require more invasive treatments. Occipital nerve stimulation (ONS) is one of these new therapeutic options. The aim of this data review is to evaluate the clinical impact of ONS and whether the neuropsychological aspects of anxiety and depression can be considered as predictors of therapeutic effects. Seventeen migraine patients, according to the ICHD-II classification, were treated with ONS. At baseline all patients were assessed by numeric rating scale (NRS), Migraine Disability Assessment (MIDAS), SF-36 Health Survey (SF-36), Beck Depression Inventory II (BDI II), and Beck Anxiety Inventory (BAI) questionnaires. MIDAS and NRS were re-assessed at 3 and 12 month follow-up visits, while SF-36 was evaluated after 12 months of stimulation. The population was divided in 2 subgroups based on MIDAS improvement, and BDI II and BAI scores in the 2 subpopulations were compared to investigate whether anxiety and depression can be considered as predictive factors of clinical outcomes. MIDAS showed a significant reduction both at 3 and 12 month visits and NRS scale showed the same trend. The SF-36 questionnaire showed a significant improvement not only in Physical Component Summary (PCS) and Mental Component Summary (MCS) indices, but also in sub-dimensions. Patients who reported a MIDAS improvement ≤ 40% showed a significant difference in BDI-II test at baseline. Significant clinical improvements were obtained already after 3 months of treatment and stayed stable throughout the first year after the procedure. ONS seems to be an effective and safe treatment for chronic migraine. The effects of ONS can be optimized by a multidisciplinary diagnostic and therapeutic approach, especially for the importance of the psychological factors in pain perception and their correlation with a good therapeutic outcome. Our experience highlighted that a multidisciplinary team which includes psychological support and psychosocial rehabilitation is essential for the success of this therapy.
约1%的慢性偏头痛患者对药物治疗无反应，需要更具侵入性的治疗。枕神经刺激（ONS）是这些新的治疗选择之一。本数据综述的目的是评估ONS的临床影响，以及焦虑和抑郁的神经心理学方面是否可被视为治疗效果的预测指标。根据国际头痛疾病分类第二版（ICHD-II），17名偏头痛患者接受了ONS治疗。在基线时，所有患者均通过数字评分量表（NRS）、偏头痛残疾评估（MIDAS）、SF-36健康调查（SF-36）、贝克抑郁量表第二版（BDI II）和贝克焦虑量表（BAI）问卷进行评估。在3个月和12个月的随访中对MIDAS和NRS进行重新评估，而在刺激12个月后评估SF-36。根据MIDAS改善情况将人群分为2个亚组，并比较2个亚组中的BDI II和BAI评分，以研究焦虑和抑郁是否可被视为临床结果的预测因素。MIDAS在3个月和12个月的随访中均显著降低，NRS量表也呈现相同趋势。SF-36问卷不仅在身体成分总结（PCS）和心理成分总结（MCS）指标上有显著改善，在各子维度上也有改善。报告MIDAS改善≤40%的患者在基线时BDI-II测试有显著差异。治疗3个月后即取得显著的临床改善，并在术后第一年保持稳定。ONS似乎是一种治疗慢性偏头痛的有效且安全的方法。通过多学科诊断和治疗方法可以优化ONS的效果，特别是考虑到心理因素在疼痛感知中的重要性及其与良好治疗结果的相关性。我们的经验表明，一个包括心理支持和社会心理康复的多学科团队对于这种治疗的成功至关重要。
