Department of Neurology, Headache Research Unit, University of Liège, Citadelle Hospital, Liege, Belgium.
Headache Unit, IRCCS Neuromed, Pozzilli (IS), Italy.
Prog Brain Res. 2020;255:249-274. doi: 10.1016/bs.pbr.2020.06.009. Epub 2020 Jul 6.
Noninvasive neurostimulation methods are particularly suited for migraine treatment thanks to their most favorable adverse event profile. Among them, noninvasive vagus nerve stimulation (nVNS) has raised great hope because of the role the vagus nerve is known to play in pain modulation, inflammation and brain excitability. We will critically review the clinical studies performed for migraine attack treatment and migraine prevention with the GammaCore® device, which allows cervical vagus nerve stimulation. nVNS is effective for the abortive treatment of migraine attacks, although the effect size is modest and numbers-to-treat appear not superior to those of other noninvasive neurostimulation methods, and inferior to those of oral triptans. The effect of nVNS with the GammaCore® in migraine prevention is not superior to sham stimulation, except possibly in patients with high adherence to the treatment. Both in acute and preventive trials, nVNS was characterized by an outstanding tolerance and safety profile, like the other noninvasive neurostimulation techniques. In physiological animal and human studies, cervical nVNS was shown to generate somatosensory evoked responses, to modulate pain perception and several areas of the cerebral pain network, and to inhibit experimental cortical spreading depression, which are relevant effects for migraine therapy.
非侵入性神经刺激方法因其不良反应谱最有利而特别适用于偏头痛的治疗。其中，由于迷走神经在疼痛调节、炎症和大脑兴奋性方面的作用，非侵入性迷走神经刺激（nVNS）引起了极大的关注。我们将批判性地回顾使用 GammaCore®设备进行的偏头痛发作治疗和偏头痛预防的临床研究，该设备可实现颈部迷走神经刺激。nVNS 对偏头痛发作的中止治疗有效，尽管其效果大小适中，且治疗人数似乎并不优于其他非侵入性神经刺激方法，也不如口服曲普坦类药物。除了治疗依从性高的患者外，GammaCore®的 nVNS 在偏头痛预防中的效果并不优于假刺激。在急性和预防性试验中，nVNS 的耐受性和安全性都非常出色，与其他非侵入性神经刺激技术一样。在生理动物和人体研究中，颈部 nVNS 被证明可以产生体感诱发电位，调节疼痛感知和大脑疼痛网络的几个区域，并抑制实验性皮质扩散性抑制，这些都是偏头痛治疗的相关效应。
