目的:慢性头痛仍然是全球残疾和疼痛的主要原因。尽管文献已经广泛描述了头痛治疗和预防的药理学选择,关于神经调节干预治疗对常规药物治疗无反应的头痛的疗效的数据仍然很少.这篇综述的主要目的是评估有关颈脊髓刺激(cSCS)治疗任何顽固性慢性头痛的疗效的文献。包括偏头痛(有或没有先兆),丛集性头痛,紧张性头痛,和其他类型的头痛。
方法:根据系统评价和荟萃分析指南的首选报告项目,我们通过确定PubMed中的研究进行了系统评价,Embase(Scopus),WebofScience,和Cochrane中央对照试验注册,评估cSCS治疗慢性头痛。数据是定性合成的,主要结果是头痛强度和频率。次要结果是不良反应。
结果:总计,包括107名患者的16项研究符合纳入标准。研究结果是根据头痛的类型提出的,其中包括有或没有先兆的偏头痛,丛集性头痛,三叉神经病变,枕骨神经痛,创伤后头痛,颈源性头痛,伴有自主神经症状的短期单侧神经性头痛,中风后面部疼痛。根据建议的分级,评估,开发和评估标准,有非常低质量的证据表明cSCS与偏头痛频率的减少有关,偏头痛强度,和三叉神经病变的强度。cSCS导线的放置范围为C1至C4。
结论:我们的综述表明,来自观察性研究的有希望的数据表明,cSCS可能有助于降低慢性顽固性头痛的频率和强度。未来动力良好,需要进行随机对照试验.
OBJECTIVE: Chronic headache remains a major cause of disability and pain worldwide. Although the literature has extensively described pharmacologic options for headache treatment and prophylaxis, there remains a paucity of data on the efficacy of neuromodulation interventions for treatment of headache unresponsive to conventional pharmacologic therapy. The primary aim of this
review was to appraise the literature for the efficacy of cervical spinal cord stimulation (cSCS) in treating any intractable chronic headache, including migraine headaches (with or without aura), cluster headache, tension headache, and other types of headaches.
METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we performed a systematic
review by identifying studies in PubMed, Embase (Scopus), Web of Science, and Cochrane Central Register of Controlled Trials that assessed cSCS to treat chronic headache. Data were synthesized qualitatively, with primary outcomes of headache intensity and frequency. The secondary outcome was adverse effects.
RESULTS: In total, 16 studies comprising 107 patients met the inclusion criteria. Findings were presented based on type of headache, which included migraine headache with or without aura, cluster headache, trigeminal neuropathy, occipital neuralgia, posttraumatic headache, cervicogenic headache, short-lasting unilateral neuralgiform headache with autonomic symptoms, and poststroke facial pain. Per the Grading of Recommendations, Assessment, Development and Evaluations criteria, there was very low-quality evidence that cSCS is associated with a decrease in migraine headache frequency, migraine headache intensity, and trigeminal neuropathy intensity. Placement for cSCS leads ranged from C1 to C4.
CONCLUSIONS: Our
review suggests promising data from observational studies that cSCS may be helpful in decreasing frequency and intensity of chronic intractable headache. Future well-powered, randomized controlled trials are needed.