Maxey Benjamin S, Pruitt John W, Deville Ashley, Montgomery Carver, Kaye Alan D, Urits Ivan
School of Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA.
Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, USA.
Curr Pain Headache Rep. 2022 Apr;26(4):337-346. doi: 10.1007/s11916-022-01026-w. Epub 2022 Mar 14.
This paper will examine the efficacy and safety of occipital nerve stimulation as a non-pharmacological alternative treatment for migraine.
Migraine is characterized as a primary headache disorder with possible premonitory and aura phases, both of which vary greatly in symptomatology. The most common treatments for chronic migraine are pharmacological and are aimed at both acute relief (e.g., nonsteroidal anti-inflammatory drugs, triptans, and ergots) and prophylaxis (e.g., propranolol, valproic acid, and topiramate). For patients with medically refractory migraine, acute relief medication overuse can increase the risk of developing more severe and more frequent migraine attacks. Occipital nerve stimulation is a non-pharmacological alternative treatment for chronic migraine, which could eliminate the risk of adverse effects from acute relief medication overuse. Neurostimulation is thought to prevent pain by blocking signal transduction from small nociceptive fibers with non-painful signaling in larger adjacent fibers. Existing data from clinical trials support the overall safety and efficacy of occipital nerve stimulation for the treatment of chronic migraine. However, few large controlled, double-blinded studies have been conducted, due to both practical and ethical concerns. Currently, occipital nerve stimulation is available as an off-label use of neurostimulation for pain prevention but is not approved by the FDA specifically for the treatment of chronic migraine.
本文将探讨枕神经刺激作为偏头痛非药物替代治疗方法的疗效和安全性。
偏头痛是一种原发性头痛疾病，可能有先兆期和发作期，两者症状差异很大。慢性偏头痛最常见的治疗方法是药物治疗，旨在实现急性缓解（如非甾体抗炎药、曲坦类药物和麦角类药物）和预防（如普萘洛尔、丙戊酸和托吡酯）。对于药物难治性偏头痛患者，过度使用急性缓解药物会增加发生更严重、更频繁偏头痛发作的风险。枕神经刺激是慢性偏头痛的一种非药物替代治疗方法，可消除过度使用急性缓解药物产生不良反应的风险。神经刺激被认为是通过阻断来自小伤害性纤维的信号转导，并在相邻的大纤维中传递非疼痛信号来预防疼痛。临床试验的现有数据支持枕神经刺激治疗慢性偏头痛的总体安全性和有效性。然而，由于实际和伦理方面的考虑，很少进行大型对照双盲研究。目前，枕神经刺激作为神经刺激预防疼痛的一种非标签用途，但尚未获得美国食品药品监督管理局专门批准用于治疗慢性偏头痛。
