Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Brazil.
Headache. 2016 Nov;56(10):1565-1596. doi: 10.1111/head.12981.
To evaluate the efficacy of noninvasive brain stimulation (NIBS) on pain control in migraine patients.
Recent studies have used NIBS as an abortive and prophylactic treatment for migraine; however, its efficacy regarding meaningful clinical effects remains to be critically analyzed.
Systematic review of controlled clinical trials.
Searches were conducted in six databases: MEDLINE (via PubMed), LILACS (via BIREME), CINAHL (via EBSCO), Scopus (via EBSCO), Web of Science, and CENTRAL. Two independent authors searched for randomized controlled clinical trials published through until January 2016 that involved the use of transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) in migraineurs. Studies which met the eligibility criteria were assessed and methodological quality was examined using the Cochrane tool for assessing risk of bias. Information about pain intensity (primary outcome), migraine attacks, painkiller intake, and adverse effects were extracted.
Eight studies were included in the quantitative analysis with 153 migraine patients that received NIBS and 143 sham NIBS. In overall meta-analysis, we did not find significant results for pain intensity (SMD: -0.61; CI: -1.35 to 0.13; P = .11), for migraine attacks (SMD: -0.44; 95%; CI: -1.15 to 0.26; P = .22), and for painkiller intake (SMD: -0.57; 95% CI: -1.21 to 0.07; P = .08). However, subgroup analysis considering only tDCS effects have demonstrated a decrease for pain intensity (SMD: -0.91; 95% CI: -1.79 to -0.03; P = .04), migraine attacks (SMD: -0.75; 95% CI: -1.25 to -0.24; P = .004), and painkiller intake (SMD: -0.64; 95% CI: -1.21 to -0.07; P = .03). Subgroup analysis for TMS did not reveal significant effects for any outcome.
Low or very low quality of evidence suggests that our primary outcome evaluation failed to find support for the superiority of NIBS over sham treatment. Although, subgroup analysis reveals that tDCS have moderate to high effects and could be a promising nonpharmacological alternative to pain control, mainly for painkiller intake reduction. However, there is a need for larger controlled trials with methodological rigor, which could increase the power of result inference.
评估非侵入性脑刺激（NIBS）在偏头痛患者疼痛控制中的疗效。
最近的研究已经将 NIBS 用作偏头痛的发作性和预防性治疗方法；然而，其对于有意义的临床效果的疗效仍需要进行批判性分析。
对照临床试验的系统性回顾。
在六个数据库中进行了检索：MEDLINE（通过 PubMed）、LILACS（通过 BIREME）、CINAHL（通过 EBSCO）、Scopus（通过 EBSCO）、Web of Science 和 CENTRAL。两位独立的作者检索了截至 2016 年 1 月发表的使用经颅直流电刺激（tDCS）和经颅磁刺激（TMS）治疗偏头痛患者的随机对照临床试验。符合入选标准的研究进行了评估，并使用 Cochrane 工具评估了偏倚风险的方法学质量。提取了疼痛强度（主要结局）、偏头痛发作、止痛药摄入和不良反应的信息。
共有 8 项研究被纳入定量分析，其中 153 名偏头痛患者接受了 NIBS 治疗，143 名接受了假 NIBS 治疗。在总体荟萃分析中，我们未发现疼痛强度（SMD：-0.61；CI：-1.35 至 0.13；P=0.11）、偏头痛发作（SMD：-0.44；95%CI：-1.15 至 0.26；P=0.22）和止痛药摄入（SMD：-0.57；95%CI：-1.21 至 0.07；P=0.08）有显著结果。然而，仅考虑 tDCS 效果的亚组分析显示疼痛强度（SMD：-0.91；95%CI：-1.79 至 -0.03；P=0.04）、偏头痛发作（SMD：-0.75；95%CI：-1.25 至 -0.24；P=0.004）和止痛药摄入（SMD：-0.64；95%CI：-1.21 至 -0.07；P=0.03）有降低趋势。TMS 的亚组分析未显示任何结果有显著效果。
低或极低质量的证据表明，我们的主要结局评估未能支持 NIBS 优于假治疗。尽管如此，亚组分析显示 tDCS 具有中到高度的效果，可能是一种有前途的非药物性疼痛控制替代方法，主要是减少止痛药的摄入。然而，需要进行更严格的、具有方法学严谨性的大规模对照试验，这可以提高结果推断的能力。
