Neurosciences Unit, CHU de Québec-Université Laval Research Center, Québec, Québec, Canada.
Service de neurochirurgie, 1401 18E rue, Office D-3618, Québec, QC, G1J 1Z4, Canada.
Syst Rev. 2019 Jul 22;8(1):181. doi: 10.1186/s13643-019-1101-x.
Defined as a headache lasting at least 15 days per month, chronic headache is reported by 3% of the general population, and a substantial proportion of them are refractory to current therapies. Occipital nerve stimulation (ONS) is a treatment option, but is still considered as a last resort treatment especially because of its invasive nature and the cost associated. Some reviews reported a limited efficacy of ONS for the treatment of migraines, with a high risk of complications. However, results reporting its efficacy and safety on other headache disorders are unclear. The aim of this review is to assess the efficacy and safety of ONS in regards to non-migrainous chronic headaches.
We will conduct a systematic review and meta-analysis of studies evaluating the use of ONS in comparison to sham stimulation or the best available treatment in patients with chronic headache. MEDLINE, CINHAL, EMBASE, PsycINFO, ECRI Institute Library, WIKISTIM, the Cochrane Library databases, and clinical trial registries will be searched for eligible studies. The review will include adult patients diagnosed with chronic headache excluding migraine. Two independent reviewers will process to the screening of studies according to titles, abstracts, and then full texts. The primary outcome is the overall reduction of head pain severity. The secondary outcomes are rates of reduction in the severity of head pain, headache frequency, and duration, use of medication, impairment, quality of life, healthcare utilization, return to work, and adverse events. Extracted data will include patients' and procedure characteristics, details on comparative treatment or sham, and clinical outcomes. The risk of bias of the studies will be also independently assessed using the Cochrane risk of bias tools.
This systematic review will allow us to better evaluate the potential role of ONS for the treatment of patients with chronic headache that are refractory to less invasive therapies. It will help to determine the degree of safety of ONS. Moreover, it will help to design and conduct future randomized controlled trials focused on patients who may better respond to such treatment.
PROSPERO CRD42019121623.
慢性头痛定义为每月至少持续 15 天的头痛，据报道，普通人群中有 3%患有慢性头痛，其中相当一部分对当前的治疗方法没有反应。枕神经刺激（ONS）是一种治疗选择，但由于其侵袭性和相关成本，仍然被认为是最后的治疗手段。一些综述报告称，ONS 治疗偏头痛的疗效有限，并发症风险高。然而，关于其他头痛疾病的疗效和安全性的报告结果尚不清楚。本综述的目的是评估 ONS 在非偏头痛性慢性头痛中的疗效和安全性。
我们将对评估 ONS 在慢性头痛患者中与假刺激或最佳现有治疗相比的使用的研究进行系统评价和荟萃分析。将在 MEDLINE、CINHAL、EMBASE、PsycINFO、ECRI 研究所图书馆、WIKISTIM、Cochrane 图书馆数据库和临床试验登记处搜索合格的研究。该综述将包括排除偏头痛的慢性头痛诊断为成人患者。两名独立的审查员将根据标题、摘要和全文对研究进行筛选。主要结局是头痛严重程度的总体降低。次要结局是头痛严重程度、头痛频率和持续时间、药物使用、残疾、生活质量、医疗保健利用、重返工作岗位和不良事件的降低率。提取的数据将包括患者和程序特征、比较治疗或假刺激的详细信息以及临床结果。还将使用 Cochrane 偏倚风险工具独立评估研究的偏倚风险。
这项系统评价将使我们能够更好地评估 ONS 治疗对微创治疗反应不佳的慢性头痛患者的潜在作用。它将有助于确定 ONS 的安全性程度。此外，它将有助于设计和开展未来专注于可能对这种治疗反应更好的患者的随机对照试验。
PROSPERO CRD42019121623。
