Clark Oliver, Mahjoub Areej, Osman Nily, Surmava Ann-Marie, Jan Saber, Lagman-Bartolome Ana Marissa
Department of Internal Medicine, Pennsylvania Hospital, 800 Spruce St, Philadelphia, PA, 19107, USA.
Division of Pediatric Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada.
Neurol Sci. 2022 Jan;43(1):153-165. doi: 10.1007/s10072-021-05664-7. Epub 2021 Oct 26.
A systematic review and meta-analysis was performed to determine the efficacy of non-invasive neuromodulation modalities for the treatment of acute migraine.
Although pharmacological treatments are the gold standard for the management of acute migraine, some patients may require non-pharmacological treatment options. Non-invasive neuromodulation may provide an alternative, and techniques include transcranial magnetic stimulation (TMS), non-invasive vagal nerve stimulation (nVNS), non-painful remote electrical stimulation (NRES), and external trigeminal nerve stimulation (e-TNS).
This systematic review and meta-analysis was performed following PRISMA guidelines. We searched PUBMED, EMBASE, ClinicalTrials.gov, Cochrane Center Register of Controlled Trials, and LILACS databases. We included randomized controlled clinical trials studying patients with migraine treated with any form of non-invasive neuromodulation. Primary outcome was pain freedom within 2 h post-treatment. Secondary outcomes were pain relief within 2-h post-treatment and sustained pain freedom and sustained pain relief 48 h post-treatment.
Pooled analysis demonstrated a significant effect of non-invasive neuromodulation on pain-free rates within 2 h (RR, 1.66; 95% CI, 1.35 to 2.05; P < 0.00001) and pain relief rates within 2 h (RR, 1.52; 95% CI, 1.13 to 2.05; P = 0.005) post-treatment. Non-invasive neuromodulation had no significant effect on sustained pain freedom at 48 h (RR, 1.56; 95% CI, 0.68 to 3.59; P = 0.29) or sustained pain relief at 48 h (RR, 1.47; 95% CI, 0.57 to 3.77; P = 0.43) after administration.
Neuromodulation has demonstrated some efficacy in acute migraine management and may be considered in the treatment paradigm of acute migraine in patients with contraindications to pharmacological therapies.
进行一项系统评价和荟萃分析，以确定非侵入性神经调节方式治疗急性偏头痛的疗效。
虽然药物治疗是急性偏头痛管理的金标准，但一些患者可能需要非药物治疗选择。非侵入性神经调节可能提供一种替代方法，技术包括经颅磁刺激（TMS）、非侵入性迷走神经刺激（nVNS）、无痛远程电刺激（NRES）和外三叉神经刺激（e-TNS）。
本系统评价和荟萃分析按照PRISMA指南进行。我们检索了PUBMED、EMBASE、ClinicalTrials.gov、Cochrane对照试验中心注册库和LILACS数据库。我们纳入了研究接受任何形式非侵入性神经调节治疗的偏头痛患者的随机对照临床试验。主要结局是治疗后2小时内无疼痛。次要结局是治疗后2小时内疼痛缓解以及治疗后48小时持续无疼痛和持续疼痛缓解。
汇总分析表明，非侵入性神经调节对治疗后2小时内的无疼痛率（RR，1.66；95%CI，1.35至2.05；P＜0.00001）和治疗后
