Danish Headache Center, Rigshospital-Glostrup, Glostrup, Denmark.
Acta Neurol Scand. 2019 Jan;139(1):4-17. doi: 10.1111/ane.13034. Epub 2018 Oct 29.
Small subsets of patients who fail to respond to pharmacological treatment may benefit from alternative treatment methods. In the last decade, neurostimulation is being explored as a potential treatment option for the patients with chronic, severely disabling refractory primary headaches. To alleviate pain, specific nerves and brain areas have been stimulated, and various methods have been explored: deep brain stimulation, occipital nerve stimulation, and sphenopalatine ganglion stimulation are among the more invasive ones, whereas transcranial magnetic stimulation and supraorbital nerve stimulation are noninvasive. Vagal nerve stimulation can be invasive or noninvasive, though this review included only data for noninvasive VNS. Most of these methods have been tested in small open-label patient series; recently, more data from randomized, controlled, and blinded studies are available. Although neurostimulation treatments have demonstrated good efficacy in many studies, it still has not been established as a standard treatment in refractory patients. This review analyzes the available evidence regarding efficacy and safety of different neurostimulation modalities for the treatment of chronic migraine and cluster headache.
一小部分对药物治疗反应不佳的患者可能会受益于替代治疗方法。在过去十年中，神经刺激作为慢性、严重致残性难治性原发性头痛患者的潜在治疗选择正在被探索。为了缓解疼痛，特定的神经和大脑区域被刺激，并且已经探索了各种方法：深部脑刺激、枕神经刺激和蝶腭神经节刺激是更具侵入性的方法，而经颅磁刺激和眶上神经刺激是非侵入性的。迷走神经刺激可以是侵入性的或非侵入性的，尽管本综述仅包括非侵入性 VNS 的数据。这些方法中的大多数已在小型开放标签患者系列中进行了测试；最近，更多来自随机、对照和盲法研究的数据可用。尽管神经刺激治疗在许多研究中显示出良好的疗效，但它尚未被确立为难治性患者的标准治疗方法。本综述分析了不同神经刺激方式治疗慢性偏头痛和丛集性头痛的疗效和安全性的现有证据。
