Mayo Clinic Arizona, Department of Neurology, Scottsdale, AZ, United States.
Guy's and St Thomas' NHS Foundation Trust, Medical Specialties, Headache and Facial Pain Centre, London, United Kingdom.
Handb Clin Neurol. 2024;199:179-200. doi: 10.1016/B978-0-12-823357-3.00003-3.
The International Neuromodulation Society defines therapeutic neuromodulation as the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body. Neuromodulation for the treatment of migraine is an evolving field offering further insight into the pathophysiology of migraine as well as advanced therapeutics. Central and peripheral neuronal targets have been explored in the efforts to reduce the frequency and severity of attacks. Invasive and noninvasive techniques have been developed, targeting either the central or peripheral nervous system. Noninvasive central neuromodulation techniques have the benefit of a low side effect profile in addition to higher level of evidence for use thanks to sham-controlled trials; however, these modalities are less clinically available for use. Noninvasive transcutaneous neuromodulation techniques that target the peripheral nervous system have provided devices that are available over the counter or by prescription. Several of these devices are effective for abortive and preventive treatment of migraine. Invasive techniques such as cranial nerve stimulation with implanted stimulator devices or spinal cord stimulation may be used for more aggressive management in patients refractory to other treatments. Overall, neuromodulation techniques can be particularly beneficial for medically complex or refractory patients, those that prefer nonmedication options, and those that have experienced adverse effects from medications.
国际神经调节学会将治疗性神经调节定义为通过向身体特定的神经部位靶向传递刺激，如电刺激或化学制剂，来改变神经活动。神经调节作为偏头痛的一种治疗方法，是一个不断发展的领域，为偏头痛的病理生理学以及先进的治疗方法提供了更深入的了解。中枢和外周神经元靶点已经被探索用于减少发作的频率和严重程度。已经开发了侵入性和非侵入性技术，针对中枢或外周神经系统。非侵入性中枢神经调节技术具有副作用谱低的优点，此外，由于假手术对照试验，其使用的证据水平更高；然而，这些方式在临床上的应用较少。针对外周神经系统的非侵入性经皮神经调节技术提供了可在柜台或处方购买的设备。这些设备中的几种对于偏头痛的发作期和预防性治疗是有效的。侵入性技术，如植入式刺激器装置的颅神经刺激或脊髓刺激，可能用于对其他治疗方法有抗药性的患者的更积极的治疗。总的来说，神经调节技术对于医学上复杂或有抗药性的患者、那些更喜欢非药物治疗的患者以及那些经历过药物不良反应的患者特别有益。
