Tana Claudio, Garcia-Azorin David, Raffaelli Bianca, Fitzek Mira Pauline, Waliszewska-Prosół Marta, Quintas Sonia, Martelletti Paolo
Center of Excellence on Headache and Geriatrics Clinic, Study of Rare Disorders, University-Hospital of Chieti, Chieti, Italy.
Headache Unit, Department of Neurology, Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain.
Adv Ther. 2025 May 8. doi: 10.1007/s12325-025-03206-7.
Chronic migraine (CM) affects approximately 2% of the general population and is defined by the persistence of migraine symptoms for at least 15 days per month for at least 3 months. CM is often refractory to common drug treatments and is associated with a significant burden in functions of daily life during ictal phases, productivity loss, and direct costs. Modulation of pain is considered pivotal to reduce its impact and to improve the quality of life among patients with CM. In recent years, neuromodulation in CM has received growing attention; however, there remains no consensus regarding the effectiveness and safety of these procedures. Previous invasive methods such as occipital nerve neurolysis and interruption of the trigeminal dorsal root are not indicated due to high rates of relapsing pain and frequent procedural complications. Although emerging neuromodulation methods, both noninvasive, such as vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS), remote electrical neuromodulation (REM), and invasive, such as deep brain stimulation (DBS), occipital nerve stimulation (ONS), and high-frequency 10-Hz spinal cord stimulation (HF-10 SNS) have demonstrated promising outcomes in early clinical trials, their use has yet to be integrated into routine clinical practice. In this review, study evidence and strength of recommendations are assessed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Other conditions such as therapeutic risk/benefit, direct and indirect costs, use of resources, and patient/clinician preferences are also evaluated.
慢性偏头痛（CM）影响着约2%的普通人群，其定义为偏头痛症状每月持续至少15天，且持续至少3个月。CM通常对常见药物治疗无效，并且在发作期会给日常生活功能带来重大负担，导致生产力下降和直接成本增加。疼痛调节被认为对于减轻其影响以及改善CM患者的生活质量至关重要。近年来，CM中的神经调节受到了越来越多的关注；然而，对于这些治疗方法的有效性和安全性仍未达成共识。由于复发疼痛率高和手术并发症频繁，以往的侵入性方法，如枕神经松解术和三叉神经背根切断术已不再适用。尽管新兴的神经调节方法，包括非侵入性的，如迷走神经刺激（VNS）、经颅磁刺激（TMS）、远程电神经调节（REM），以及侵入性的，如深部脑刺激（DBS）、枕神经刺激（ONS）和高频10赫兹脊髓刺激（HF-10 SNS）在早期临床试验中已显示出有前景的结果，但它们尚未被纳入常规临床实践。在本综述中，研究证据和推荐强度通过推荐分级、评估、制定和评价（GRADE）系统进行评估。还评估了其他情况，如治疗风险/益处、直接和间接成本、资源使用以及患者/临床医生偏好。
