Láinez Miguel J A, Jensen Rigmor
aDepartment of Neurology, Clinic University Hospital, Catholic University of Valencia, Valencia, Spain bDepartment of Neurology, Danish Headache Center, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
Curr Opin Neurol. 2015 Jun;28(3):271-6. doi: 10.1097/WCO.0000000000000196.
Neuromodulation is an alternative in the management of medically intractable cluster headache patients. Most of the techniques are invasive, but in the last 2 years, some studies using a noninvasive device have been presented. The objective of this article is to review the data using this approach.
Techniques as occipital nerve stimulation or sphenopalatine ganglion stimulation are recommended as first-line therapy in refractory cluster patients, but they are invasive and maybe associated with complications. Noninvasive vagal nerve stimulation with an external device has been tried in cluster patients. Results from clinical practice and a single randomized clinical trial have been presented showing a reduction of the number of cluster attacks/week in the patients treated with the device. The rate of adverse events was low and most of them were mild.
In the last decade, invasive neuromodulation treatments have demonstrated good efficacy in cluster refractory patients. Noninvasive approaches such as the noninvasive vagal nerve stimulation have shown efficacy in one trial and could be an easier alternative in the management of this debilitating headache. We need to replicate these results with further controlled studies and conduct basic research in order to clarify the mechanism of action.
神经调节是治疗药物难治性丛集性头痛患者的一种替代方法。大多数技术是侵入性的，但在过去两年中，出现了一些使用非侵入性设备的研究。本文的目的是回顾使用这种方法的数据。
枕神经刺激或蝶腭神经节刺激等技术被推荐为难治性丛集性头痛患者的一线治疗方法，但它们是侵入性的，可能会伴有并发症。已尝试使用外部设备对丛集性头痛患者进行非侵入性迷走神经刺激。临床实践和一项单一随机临床试验的结果表明，使用该设备治疗的患者每周丛集性发作次数减少。不良事件发生率较低，且大多数为轻度。
在过去十年中，侵入性神经调节治疗已在丛集性头痛难治性患者中显示出良好疗效。非侵入性迷走神经刺激等非侵入性方法在一项试验中显示出疗效，可能是治疗这种使人衰弱的头痛的一种更简便的替代方法。我们需要通过进一步的对照研究来重复这些结果，并开展基础研究以阐明其作用机制。
