UOC Neuroalgologia, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy.
UOC Neurologia, Salute Pubblica e Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy.
Int J Environ Res Public Health. 2021 Feb 5;18(4):1503. doi: 10.3390/ijerph18041503.
Significant side effects or drug interactions can make pharmacological management of headache disorders very difficult. Non-conventional and non-pharmacological treatments are becoming increasingly used to overcome these issues. In particular, non-invasive neuromodulation, nutraceuticals, and behavioral approaches are well tolerated and indicated for specific patient categories such as adolescents and pregnant women. This paper aims to present the main approaches reported in the literature in the management of headache disorders. We therefore reviewed the available literature published between 2010 and 2020 and performed a narrative presentation for each of the three categories (non-invasive neuromodulation, nutraceuticals, and behavioral therapies). Regarding non-invasive neuromodulation, we selected transcranial magnetic stimulation, supraorbital nerve stimulation, transcranial direct current stimulation, non-invasive vagal nerve stimulation, and caloric vestibular stimulation. For nutraceuticals, we selected Feverfew, Butterbur, Riboflavin, Magnesium, and Coenzyme Q10. Finally, for behavioral approaches, we selected biofeedback, cognitive behavioral therapy, relaxation techniques, mindfulness-based therapy, and acceptance and commitment therapy. These approaches are increasingly seen as a valid treatment option in headache management, especially for patients with medication overuse or contraindications to drug treatment. However, further investigations are needed to consider the effectiveness of these approaches also with respect to the long-term effects.
显著的副作用或药物相互作用可能使头痛疾病的药物治疗变得非常困难。非传统和非药物治疗方法正越来越多地被用于克服这些问题。特别是，非侵入性神经调节、营养保健品和行为方法耐受性良好，适用于特定的患者群体，如青少年和孕妇。本文旨在介绍文献中报道的头痛疾病管理的主要方法。因此，我们回顾了 2010 年至 2020 年期间发表的现有文献，并对每一类（非侵入性神经调节、营养保健品和行为疗法）进行了叙述性介绍。关于非侵入性神经调节，我们选择了经颅磁刺激、眶上神经刺激、经颅直流电刺激、非侵入性迷走神经刺激和冷热水前庭刺激。对于营养保健品，我们选择了小白菊、小白菊提取物、核黄素、镁和辅酶 Q10。最后，对于行为方法，我们选择了生物反馈、认知行为疗法、放松技术、正念疗法和接受与承诺疗法。这些方法在头痛管理中越来越被视为一种有效的治疗选择，尤其是对于药物过度使用或药物治疗禁忌的患者。然而，需要进一步的研究来考虑这些方法的有效性，也需要考虑其长期效果。
