Silberstein Stephen D, Yuan Hsiangkuo, Najib Umer, Ailani Jessica, Morais Andreia Lopes de, Mathew Paul G, Liebler Eric, Tassorelli Cristina, Diener Hans-Christoph
Jefferson Headache Center, Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Department of Neurology, West Virginia University, Morgantown, West Virginia, USA.
Cephalalgia. 2020 Oct;40(12):1370-1384. doi: 10.1177/0333102420941864. Epub 2020 Jul 27.
Non-invasive vagus nerve stimulation (nVNS) is a proven treatment for cluster headache and migraine. Several possible mechanisms of action by which nVNS mitigates headache have been identified.
We conducted a narrative review of recent scientific and clinical research into nVNS for headache, including findings from mechanistic studies and their possible relationships to the clinical effects of nVNS.
Findings from animal and human studies have provided possible mechanistic explanations for nVNS efficacy in headache involving four core areas: Autonomic nervous system functions; cortical spreading depression inhibition; neurotransmitter regulation; and nociceptive modulation. We discuss how overlap and interplay among these areas may underlie the utility of nVNS in the context of clinical evidence supporting its safety and efficacy as acute and preventive therapy for both cluster headache and migraine. Possible future nVNS applications are also discussed.
Significant progress over the past several years has yielded valuable mechanistic and clinical evidence that, combined with the excellent safety and tolerability profile of nVNS, suggests that it should be considered a first-line treatment for both acute and preventive treatment of cluster headache, an effective option for acute treatment of migraine, and a highly relevant, practical option for migraine prevention.
非侵入性迷走神经刺激（nVNS）是一种已被证实的治疗丛集性头痛和偏头痛的方法。已经确定了nVNS减轻头痛的几种可能作用机制。
我们对近期关于nVNS治疗头痛的科学和临床研究进行了叙述性综述，包括机制研究的结果及其与nVNS临床效果的可能关系。
动物和人体研究的结果为nVNS在头痛治疗中的疗效提供了可能的机制解释，涉及四个核心领域：自主神经系统功能；皮质扩散性抑制；神经递质调节；以及伤害性调制。我们讨论了在支持其作为丛集性头痛和偏头痛的急性和预防性治疗的安全性和有效性的临床证据背景下，这些领域之间的重叠和相互作用如何可能是nVNS效用的基础。还讨论了nVNS未来可能的应用。
过去几年取得的重大进展产生了有价值的机制和临床证据，结合nVNS出色的安全性和耐受性，表明它应被视为丛集性头痛急性和预防性治疗的一线治疗方法、偏头痛急性治疗的有效选择以及偏头痛预防的高度相关实用选择。
