Villar-Martinez Maria Dolores, Goadsby Peter J
Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
NIHR King's Clinical Research Facility, SLaM Biomedical Research Centre, King's College Hospital, London, United Kingdom.
Front Pain Res (Lausanne). 2023 Mar 13;4:1062892. doi: 10.3389/fpain.2023.1062892. eCollection 2023.
Primary headache disorders can be remarkably disabling and the therapeutic options available are usually limited to medication with a high rate of adverse events. Here, we discuss the mechanism of action of non-invasive vagal nerve stimulation, as well as the findings of the main studies involving patients with primary headaches other than migraine or cluster headache, such as hemicrania continua, paroxysmal hemicrania, cough headache, or short-lasting neuralgiform headache attacks (SUNCT/SUNA), in a narrative analysis. A bibliographical search of low-prevalence disorders such as rare primary headaches retrieves a moderate number of studies, usually underpowered. Headache intensity, severity, and duration showed a clinically significant reduction in the majority, especially those involving indomethacin-responsive headaches. The lack of response of some patients with a similar diagnosis could be due to a different stimulation pattern, technique, or total dose. The use of non-invasive vagal nerve stimulation for the treatment of primary headache disorders represents an excellent option for patients with these debilitating and otherwise refractory conditions, or that cannot tolerate several lines of preventive medication, and should always be considered before contemplating invasive, non-reversible stimulation techniques.
原发性头痛疾病可能会导致严重的功能障碍，而现有的治疗选择通常局限于药物治疗，且药物不良反应发生率较高。在此，我们通过叙述性分析讨论非侵入性迷走神经刺激的作用机制，以及涉及除偏头痛或丛集性头痛之外的原发性头痛患者（如持续性偏侧头痛、发作性偏侧头痛、咳嗽性头痛或短暂性神经痛样头痛发作[SUNCT/SUNA]）的主要研究结果。对罕见原发性头痛等低患病率疾病进行文献检索，得到的研究数量适中，但通常样本量不足。大多数研究显示头痛强度、严重程度和持续时间有显著临床降低，尤其是那些涉及对吲哚美辛有反应的头痛的研究。一些诊断相似的患者缺乏反应可能是由于刺激模式、技术或总剂量不同。对于患有这些使人衰弱且难以治疗的疾病、或无法耐受多种预防性药物治疗的患者，使用非侵入性迷走神经刺激治疗原发性头痛疾病是一个很好的选择，并且在考虑侵入性、不可逆刺激技术之前应始终予以考虑。
