TY - JOUR
T1 - Cervical Noninvasive Vagus Nerve Stimulation for Migraine and Cluster Headache
T2 - A Systematic Review and Meta-Analysis
AU - Lai, Yin Hsuan
AU - Huang, Yu Chen
AU - Huang, Liang Ti
AU - Chen, Ruei Ming
AU - Chen, Chiehfeng
N1 - © 2020 International Neuromodulation Society.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Background: Noninvasive vagus nerve stimulation (nVNS) has been proposed as a new neuromodulation therapy to treat primary headache disorders. The purpose of this study was to analyze the effectiveness and safety of peripheral nerve stimulation of the cervical branch of the vagal nerve for primary headache disorders. Methods: A systematic review and meta-analysis of the literature was carried out on randomized controlled trials of nVNS for treating headaches. We searched the Medline, Embase, and CENTRAL databases until January 29, 2019. A random-effects model was used to report all outcomes. The primary outcomes were a reduction in headache days or attacks and pain-free status within 30 min. Secondary outcomes were: the pain-relief status within 30 min, the pain-relief status at 60 min, abortive medication use, ≥50% responder rate, pain-free status in ≥50% of treated attacks, adverse events, and satisfaction. Results: In total, 983 patients were included from six trials. We found that nVNS was effective in achieving a pain-free status within 30 min (odds ratio [OR], 2.27; 95% confidence interval [CI], 1.16~4.44; p = 0.02), pain-relief status within 30 min (OR, 1.8; 95% CI, 1.17~2.78; p = 0.007), pain-relief status at 60 min (OR, 1.93; 95% CI, 1.2~3.1; p = 0.006), a reduction in abortive medication use (OR, 0.61; 95% CI, 0.41~0.92; p = 0.02), and pain-free status in ≥50% of treated attacks (OR, 2.15; 95% CI, 1.27~3.66; p = 0.005) compared to sham-device treatment. There were no significant differences in decreased headache days (standardized mean difference (SMD), −0.159; 95% CI, −0.357~0.04; p = 0.117), adverse events (OR, 1.084; 95% CI, 0.559~2.104; p = 0.811), or satisfaction (OR, 1.45; 95% CI, 0.97~2.17; p = 0.07) between nVNS and sham-device treatment. The ≥50% responder rate could not be determined (OR, 3.34; 95% CI, 0.83~13.33; p = 0.09; I2 = 73%). Conclusions: Cervical nVNS is effective for acute pain relief for migraine and cluster headache. Systematic review registration: PROSPERO registration number CRD42019126009.
AB - Background: Noninvasive vagus nerve stimulation (nVNS) has been proposed as a new neuromodulation therapy to treat primary headache disorders. The purpose of this study was to analyze the effectiveness and safety of peripheral nerve stimulation of the cervical branch of the vagal nerve for primary headache disorders. Methods: A systematic review and meta-analysis of the literature was carried out on randomized controlled trials of nVNS for treating headaches. We searched the Medline, Embase, and CENTRAL databases until January 29, 2019. A random-effects model was used to report all outcomes. The primary outcomes were a reduction in headache days or attacks and pain-free status within 30 min. Secondary outcomes were: the pain-relief status within 30 min, the pain-relief status at 60 min, abortive medication use, ≥50% responder rate, pain-free status in ≥50% of treated attacks, adverse events, and satisfaction. Results: In total, 983 patients were included from six trials. We found that nVNS was effective in achieving a pain-free status within 30 min (odds ratio [OR], 2.27; 95% confidence interval [CI], 1.16~4.44; p = 0.02), pain-relief status within 30 min (OR, 1.8; 95% CI, 1.17~2.78; p = 0.007), pain-relief status at 60 min (OR, 1.93; 95% CI, 1.2~3.1; p = 0.006), a reduction in abortive medication use (OR, 0.61; 95% CI, 0.41~0.92; p = 0.02), and pain-free status in ≥50% of treated attacks (OR, 2.15; 95% CI, 1.27~3.66; p = 0.005) compared to sham-device treatment. There were no significant differences in decreased headache days (standardized mean difference (SMD), −0.159; 95% CI, −0.357~0.04; p = 0.117), adverse events (OR, 1.084; 95% CI, 0.559~2.104; p = 0.811), or satisfaction (OR, 1.45; 95% CI, 0.97~2.17; p = 0.07) between nVNS and sham-device treatment. The ≥50% responder rate could not be determined (OR, 3.34; 95% CI, 0.83~13.33; p = 0.09; I2 = 73%). Conclusions: Cervical nVNS is effective for acute pain relief for migraine and cluster headache. Systematic review registration: PROSPERO registration number CRD42019126009.
KW - Cluster headache
KW - headache
KW - migraine
KW - noninvasive vagus nerve stimulation
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U2 - 10.1111/ner.13122
DO - 10.1111/ner.13122
M3 - Review article
C2 - 32166843
AN - SCOPUS:85081673018
SN - 1094-7159
VL - 23
SP - 721
EP - 731
JO - Neuromodulation
JF - Neuromodulation
IS - 6
ER -