片頭痛・群発頭痛治療における非侵襲的ニューロモデュレーション

Non-Invasive Neuromodulation for the Treatment of Migraine and Cluster Headache

片頭痛・群発頭痛の薬物治療は不十分な治療効果や有害事象によるアドヒアランス低下が問題となっている。一方，非侵襲的ニューロモデュレーションは手術不要で比較的安価であり重篤な有害事象がないため，近年注目を集めつつある。経皮的三叉神経刺激装置，および経頭蓋磁気刺激装置が片頭痛の急性期治療および予防療法に，非侵襲的迷走神経刺激装置が片頭痛・群発頭痛の急性期治療および予防療法に有効である。

Abstract

Migraine and cluster headache are common headache disorders that impact patients' quality of life. The pharmacotherapy for acute headache attacks is sometimes ineffective, and the adherence to preventive medications is low due to their side effects and/or lack of efficacy. Recently, several non-invasive neuromodulation devices for primary headache disorders have been launched and attracted the attention of patients and physicians because of their practicality, safety, and the possibility of becoming new treatment options. In this review, we describe external trigeminal nerve stimulation (eTNS), non-invasive vagal nerve stimulation (nVNS), and single-pulse transcranial magnetic stimulation (sTMS) which have been well studied in recent randomized sham-controlled trials and open-label studies. We also describe their mechanisms of action and adverse events.