Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Headache. 2019 Mar;59(3):339-357. doi: 10.1111/head.13479. Epub 2019 Jan 23.
Headache is among the most prevalent causes of disability worldwide. Non-pharmacologic interventions, including neuromodulation therapies, have been proposed in patients who are treatment resistant or intolerant to medications.
To perform a systematic review on the use of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) for the treatment of specific headache disorders (ie, migraine, tension, cluster, posttraumatic).
Data sources: Ovid MEDLINE, Cochrane Central Register of Clinical Trials, Embase, Scopus, PsycINFO.
All references were reviewed by 2 independent researchers (3039 abstracts, duplicates removed). Records were selected by inclusion criteria for participants (adults 18-65 with primary or secondary headaches), interventions (TMS and tDCS applied as headache treatment), comparators (sham or alternative standard of care), and study type (cohort, case-control, and randomized controlled trials [RCT]). Studies were assessed using the Cochrane Risk of Bias Tool and overall quality determined through the GRADE Tool. A structured synthesis was performed due to heterogeneity of participants and methods.
Thirty-four studies were included: 16 rTMS, 6 TMS (excluding rTMS), and 12 tDCS. The majority investigated treatment for migraine (19/22 TMS, 8/12 tDCS). Quality of evidence ranged from very low to high.
Of all TMS and tDCS modalities, rTMS is most promising with moderate evidence that it contributes to reductions in headache frequency, duration, intensity, abortive medication use, depression, and functional impairment. However, only few studies reported changes greater than sham treatment. Further high-quality RCTs with standardized protocols are required for each specific headache disorder to validate a treatment effect. Registration Number: PROSPERO 2017 CRD42017076232.
头痛是全球最常见的致残原因之一。对于药物治疗抵抗或不耐受的患者，已经提出了非药物干预措施，包括神经调节疗法。
对经颅磁刺激（TMS）和经颅直流电刺激（tDCS）治疗特定头痛疾病（即偏头痛、紧张性头痛、丛集性头痛、创伤后头痛）的应用进行系统评价。
数据来源：Ovid MEDLINE、Cochrane 临床试验中央注册库、Embase、Scopus、PsycINFO。
由 2 名独立研究人员（3039 篇摘要，去除重复）对所有参考文献进行审查。记录根据纳入标准进行选择，纳入标准为：参与者（18-65 岁的原发性或继发性头痛成人）、干预措施（TMS 和 tDCS 作为头痛治疗）、对照（假对照或替代标准护理）和研究类型（队列、病例对照和随机对照试验）。研究采用 Cochrane 偏倚风险工具进行评估，总体质量通过 GRADE 工具确定。由于参与者和方法的异质性，进行了结构化综合。
共纳入 34 项研究：16 项重复经颅磁刺激（rTMS）、6 项 TMS（不包括 rTMS）和 12 项 tDCS。大多数研究调查了偏头痛的治疗（22 项 TMS 中的 19 项、12 项 tDCS 中的 8 项）。证据质量从极低到高。
在所有 TMS 和 tDCS 模式中，rTMS 最有前景，有中度证据表明它有助于减少头痛发作频率、持续时间、强度、预防性药物使用、抑郁和功能障碍。然而，只有少数研究报告了大于假治疗的变化。需要针对每种特定的头痛疾病进行更多高质量的 RCT，并采用标准化方案，以验证治疗效果。注册号：PROSPERO 2017 CRD42017076232。
