de Tommaso M, Delussi M
Funct Neurol. 2017 Jul/Sep;32(3):123-130. doi: 10.11138/fneur/2017.32.3.123.
Reduced habituation of the nociceptive blink reflex (NBR) is considered a trait marker for genetic predisposition to migraine. In this open-label randomized controlled study, we aimed to test the efficacy of a biofeedback training based on learning of habituation of the NBR (NBR biofeedback) compared with pharmacological (topiramate) treatment and NBR biofeedback plus topiramate treatment in a cohort of migraine without aura patients eligible for prophylaxis. Thirty-three migraine patients were randomly assigned to three months of treatment with: 1) NBR biofeedback, 2) NBR biofeedback plus topiramate 50 mg (b.i.d.), or 3) topiramate 50 mg (b.i.d.). Frequency of headache and disability changes were the main study outcomes. Anxiety, depression, sleep, fatigue, quality of life, allodynia and pericranial tenderness were also evaluated. NBR biofeedback reduced the R2 area, without improving R2 habituation. However, it reduced the frequency of headache and disability, similarly to the combined treatment and topiramate alone. Reduced habituation of the NBR is a stable neurophysiological pattern, scarcely modifiable by learning procedures. Training methods able to act on stress-related responses may modulate cortical mechanisms inducing migraine onset and trigeminal activation under stressful trigger factors.
伤害性眨眼反射（NBR）的习惯化降低被认为是偏头痛遗传易感性的一个特质标记。在这项开放标签随机对照研究中，我们旨在测试基于NBR习惯化学习的生物反馈训练（NBR生物反馈）与药物（托吡酯）治疗以及NBR生物反馈加托吡酯治疗在一组适合预防性治疗的无先兆偏头痛患者中的疗效。33名偏头痛患者被随机分配接受为期三个月的治疗：1）NBR生物反馈，2）NBR生物反馈加50毫克托吡酯（每日两次），或3）50毫克托吡酯（每日两次）。头痛频率和残疾变化是主要研究结果。还评估了焦虑、抑郁、睡眠、疲劳、生活质量、痛觉过敏和颅周压痛。NBR生物反馈减少了R2面积，但没有改善R2习惯化。然而，它减少了头痛频率和残疾，与联合治疗和单独使用托吡酯类似。NBR习惯化降低是一种稳定的神经生理模式，很难通过学习程序改变。能够作用于应激相关反应的训练方法可能会调节在应激触发因素下诱发偏头痛发作和三叉神经激活的皮质机制。
