Transcutaneous electrical stimulation of the vagus nerve as a migraine treatment: systematic review
Estimulação elétrica transcutânea do nervo vago como tratamento da migrânea: revisão sistemática
Tania Gouvêa Thomaz; Andrée Carolle Mariane Amany Kouassi; Arthur dos Santos Leite Neiva Neves; Gisele Fernandes de Sena
Abstract
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: Migrânea é um tipo de cefaleia primária cujo controle se faz principalmente por fármacos para tratamento da crise ou como profilaxia. Os efeitos adversos e o seu alto custo justificam a busca por opções de tratamento não farmacológicas. Existem evidências de que a estimulação elétrica do nervo vago (VNS) é capaz de modular estruturas relacionadas à fisiopatologia da migrânea. O objetivo deste estudo foi investigar a eficácia da VNS de forma transcutânea (tVNS) no tratamento agudo ou profilático da migrânea com e sem aura.
CONTEÚDO: Foi feita uma busca na base de dados Pub-med utilizando todos os descritores para estimulação do nervo vago e migrânea, sem limite temporal e com o filtro “ensaio clínico randomizado” (ECR). Essa estratégia de busca identificou, no final, sete artigos que foram lidos integralmente e submetidos a uma análise de qualidade através da ferramenta do Centro de Medicina Baseada em Evidências de Oxford. Dos sete ECRs encontrados, 4 eram estudos de profilaxia e 3 de tratamento agudo.
CONCLUSÃO: Existe algum comprometimento da validade interna de todos os estudos. A profilaxia da migrânea com tVNS não apresentou benefícios relevantes que justifiquem seu uso, principalmente com um protocolo de pouca aderência. O tratamento agudo da migrânea com a tNVS se mostrou eficaz em parte dos pacientes e pode ser uma opção não farmacológica de tratamento. Esses resultados justificam a realização de novos ECRs, de modo que não restem dúvidas sobre a sua validade interna.
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References
1 Ashina M. Migraine. Ropper AH, editor. N Engl J Med. 2020;383(19):1866-76.
2 Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. Pathophysiology of migraine: a disorder of sensory processing. Physiol Rev. 2017;97(2):553-622.
3 Charles A. The pathophysiology of migraine: implications for clinical management. Lancet Neurol. 2018;17(2):174-82.
4 Recomendações para o tratamento profilático da migrânea: Consenso da Sociedade Brasileira de Cefaleia. Arq Neuro-Psiquiatr 2002;60(1):159-69.
5 Martelletti P, Jensen RH, Antal A, Arcioni R, Brighina F, de Tommaso M, Franzini A, Fontaine D, Heiland M, Jürgens TP, Leone M, Magis D, Paemeleire K, Palmisani S, Paulus W, May A; European Headache Federation. Neuromodulation of chronic headaches: position statement from the European Headache Federation. J Headache Pain. 2013;14(1):86.
6 May A, Burstein R. Hypothalamic regulation of headache and migraine. Cephalalgia. 2019;39(13):1710-9.
7 Stankewitz A, Keidel L, Rehm M, Irving S, Kaczmarz S, Preibisch C, Witkovsky V, Zimmer C, Schulz E, Toelle TR. Migraine attacks as a result of hypothalamic loss of control. Neuroimage Clin. 2021;32:102784.
8 Gollion C, De Icco R, Dodick DW, Ashina H. The premonitory phase of migraine is due to hypothalamic dysfunction: revisiting the evidence. J Headache Pain. 2022;23(1):158.
9 Lanska DJ. Corning and vagal nerve stimulation for seizures in the 1880s. Neurology. 2002;58(3):452-9.
10 Howland RH. Vagus nerve stimulation. Curr Behav Neurosci Rep. 2014;1(2):64-73.
11 Yuan H, Silberstein SD. Vagus nerve and vagus nerve stimulation, a comprehensive review: part I. Headache. 2016;56(1):71-8.
12 Yuan H, Silberstein SD. Vagus nerve and vagus nerve stimulation, a comprehensive review: part II. Headache. 2016;56(2):259-66.
13 Yuan H, Silberstein SD. Vagus nerve and vagus nerve stimulation, a comprehensive review: part III. Headache. 2016;56(3):479-90.
14 Kirchner A, Birklein F, Stefan H, Handwerker HO. Left vagus nerve stimulation suppresses experimentally induced pain. Neurology. 2000;55(8):1167-71.
15 Beekwilder JP, Beems T. Overview of the clinical applications of vagus nerve stimulation. J Clin Neurophysiol. 2010;27(2):130-8.
16 Mauskop A. Vagus nerve stimulation relieves chronic refractory migraine and cluster headaches. Cephalalgia. 2005;25(2):82-6.
17 Magis D, Gérard P, Schoenen J. Transcutaneous Vagus Nerve Stimulation (tVNS) for headache prophylaxis: initial experience. J Headache Pain. 2013;14(Suppl 1):P198.
18 Hord ED, Evans MS, Mueed S, Adamolekun B, Naritoku DK The effect of vagus nerve stimulation on migraines. J Pain. 2003;4(9):530-4.
19 Lenaerts ME, Oommen KJ, Couch JR, Skaggs V. Can vagus nerve stimulation help migraine? Cephalalgia. 2008;28(4):392-5.
20 Moher D, Liberati A, TetzlaffJ, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. International J Surg. 2010;8(5):336-41.
21 Centre for Evidence-Based Medicine, University of Oxford. Critical Appraisal Tools-Centre for Evidence-Based Medicine. Available from:
22 Straube A, Ellrich J, Eren O, Blum B, Ruscheweyh R. Treatment of chronic migraine with transcutaneous stimulation of the auricular branch of the vagal nerve (auricular t-VNS): a randomized, monocentric clinical trial. J Headache Pain. 2015;16(1):63.
23 Silberstein SD, Calhoun AH, Lipton RB, Grosberg BM, Cady RK, Dorlas S, Simmons KA, Mullin C, Liebler EJ, Goadsby PJ, Saper JR; EVENT Study Group. Chronic migraine headache prevention with noninvasive vagus nerve stimulation: The EVENT study. Neurology. 2016;87(5):529-38.
24 Diener HC, Goadsby PJ, Ashina M, Al-Karagholi MAM, Sinclair A, Mitsikostas D, Magis D, Pozo-Rosich P, Irimia Sieira P, Làinez MJ, Gaul C, Silver N, Hoffmann J, Marin J, Liebler E, Ferrari MD. Non-invasive vagus nerve stimulation (nVNS) for the preventive treatment of episodic migraine: the multicentre, double-blind, randomised, sham-controlled PREMIUM trial. Cephalalgia. 2019;39(12):1475-87.
25 Najib U, Smith T, Hindiyeh N, Saper J, Nye B, Ashina S, McClure CK, Marmura MJ, Chase S, Liebler E, Lipton RB. Non-invasive vagus nerve stimulation for prevention of migraine: The multicenter, randomized, double-blind, sham-controlled PREMIUM II trial. Cephalalgia. 2022;42(7):560-9.
26 Tassorelli C, Grazzi L, de Tommaso M, Pierangeli G, Martelletti P, Rainero I, Dorlas S, Geppetti P, Ambrosini A, Sarchielli P, Liebler E, Barbanti P; PRESTO Study Group. Noninvasive vagus nerve stimulation as acute therapy for migraine: The randomized PRESTO study. Neurology. 2018;91(4):e364-e373.
27 Martelletti P, Barbanti P, Grazzi L, Pierangeli G, Rainero I, Geppetti P, Ambrosini A, Sarchielli P, Tassorelli C, Liebler E, De Tommaso M. Consistent effects of non-invasive vagus nerve stimulation (nVNS) for the acute treatment of migraine: additional findings from the randomized, sham-controlled, double-blind PRESTO trial. J Headache Pain. 2018;19(1):101.
28 Grazzi L, Tassorelli C, De Tommaso M, Pierangeli G, Martelletti P, Rainero I, Geppetti P, Ambrosini A, Sarchielli P, Liebler E, Barbanti P. Practical and clinical utility of non-invasive vagus nerve stimulation (nVNS) for the acute treatment of migraine: apost-hoc analysis of the randomized, sham-controlled, double-blind PRESTO trial. J Headache Pain. 2018;19(1):98.
29 Yuan H, Silberstein SD. Vagus nerve stimulation and headache. Headache. 2017;57(Suppl 1):29-33.
30 Tfelt-Hansen P, Diener HC. Pain freedom after 2 hours should be the primary outcome in controlled trials treating migraine attacks. Cephalalgia. 2020;40(12):1331-5.
31 Lai YH, Huang YC, Huang LT, Chen RM, Chen C. Cervical noninvasive vagus nerve stimulation for migraine and cluster headache: a systematic review and meta-analysis. Neuromodulation. 2020;23(6):721-31.
32 Warner WS, Mahan MA. What is a high-quality randomized controlled trial? Pain Med. 2022;23(4):607-9.
33 Patino CM, Ferreira JC. Internal and external validity: can you apply research study results to your patients? J Bras Pneumol. 2018;44(3):183.
34 National Library of Medicine - National Center for Biotechnology Information. Available from:
35 Rothwell PM. External validity of randomised controlled trials: “To whom do the results of this trial apply?” Lancet. 2005;365(9453):82-93.
36 Lipton RB, Goadsby PJ. Comment: Noninvasive neurostimulation for migraine should be part of the general neurologist’s therapeutic armamentarium. Neurology. 2018;91(4):167.
37 Blech B, Starling AJ, Marks LA, Wingerchuk DM, O’Carroll CB. Is Noninvasive vagus nerve stimulation a safe and effective alternative to medication for acute migraine control? Neurologist. 2020;25(4):97-100.
Submitted date:
10/03/2023
Accepted date:
09/04/2024
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