J Headache Pain:单脉冲经颅磁刺激预防性治疗难治性偏头痛

2022-06-12 MedSci原创 MedSci原创

这项开放标签分析表明,sTMS可能是一种长期预防难治性CM和HFEM有效、耐受性良好的治疗选择。

偏头痛是一种常见的、经常致残的神经系统疾病。对于经常出现偏头痛症状的患者,药物治疗是主要的防治策略。然而,已知的偏头痛口服药物治疗往往与疗效、耐受性和依从性问题有关。非侵入性神经调节方法已经成为头痛疾病和其他神经性疼痛药物治疗的一种替代或额外方法。这些治疗的基本原理是通过无创方式改变神经组织病理生理相关靶点活动来改善头痛和相关症状。其中最有前途的一种治疗方法是便携式、自我治疗的单脉冲经颅磁刺激(sTMS)。初步证据表明,sTMS在偏头痛的急性和预防性治疗中具有较好的短期疗效。但目前还不清楚这种治疗方法在难治性偏头痛的长期疗效和耐受性。

近日,麻醉疼痛领域权威杂志The Journal of Headache and Pain上发表了一篇研究文章,在这项前瞻性、单中心、开放标签、真实世界的分析中,研究人员对接受sTMS治疗的难治性高频发作性偏头痛(HFEM)和慢性偏头痛(CM)患者进行了研究。三个月的sTMS治疗对患者有反应,则继续治疗,并在12个月再次进行评估。继续治疗的临界结局是每月中度至重度头痛天数(MHD)至少减少30%(头痛频率应答者)和/或使用头痛影响测试6(HIT-6)(头痛残疾应答者)的头痛残疾减少≥4分。

153例患者纳入了分析(女性:男性=126:27,中位年龄为43岁,IQR为323-56.8)。第3个月时,153例患者中有93人(60%)对治疗有反应。与基线相比,所有患者在第3个月的月头痛天数(MHD)中位数减少5.0天,从18.0天(IQR:12.0-26.0)减少到13.0天(IQR:5.75-24.0)(P=0.002,r=−0.29),月偏头痛天数(MMD)中位数减少4.0天,从13.0天(IQR:8.75-22.0)减少到9.0天(IQR:4.0-15.25)(P=0.002,r=−0.29)。

在12个月时,153名患者中的69人(45%)报告对sTMS治疗有持续的反应。HIT-6评分总体中位数下降了4%,从基线时的66分(IQR:64-69)下降到3个月时的62分(IQR:56-65)(P<0.001,r=−0.51)。23例(15%)患者共报告了35例轻/中度不良事件。1例患者因头皮过敏而停止了sTMS治疗。

由此可见,这项开放标签分析表明,sTMS可能是一种长期预防难治性CM和HFEM有效、耐受性良好的治疗选择。

原始出处:

J.O. Lloyd. et al. Single-Pulse Transcranial Magnetic Stimulation for the preventive treatment of difficult-to-treat migraine: a 12-month prospective analysis.The Journal of Headache and Pain.2022.https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-022-01428-6

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    2022-06-12 respect
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    2022-06-13 般若傻瓜
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    2022-06-13 freve

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