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Non-invasive neuromodulation for migraine and cluster headache: a systematic review of clinical trials

Non-invasive neuromodulation therapies for migraine and cluster headache are a practical and safe alternative to pharmacologics. Comparisons of these therapies are difficult because of the heterogeneity in study designs. In this systematic review of clinical trials, the scientific rigour and clinica...

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Autores principales: Reuter, Uwe, McClure, Candace, Liebler, Eric, Pozo-Rosich, Patricia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585264/
https://www.ncbi.nlm.nih.gov/pubmed/30824632
http://dx.doi.org/10.1136/jnnp-2018-320113
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author Reuter, Uwe
McClure, Candace
Liebler, Eric
Pozo-Rosich, Patricia
author_facet Reuter, Uwe
McClure, Candace
Liebler, Eric
Pozo-Rosich, Patricia
author_sort Reuter, Uwe
collection PubMed
description Non-invasive neuromodulation therapies for migraine and cluster headache are a practical and safe alternative to pharmacologics. Comparisons of these therapies are difficult because of the heterogeneity in study designs. In this systematic review of clinical trials, the scientific rigour and clinical relevance of the available data were assessed to inform clinical decisions about non-invasive neuromodulation. PubMed, Cochrane Library and ClinicalTrials.gov databases and the WHO’s International Clinical Trials Registry Platform were searched for relevant clinical studies of non-invasive neuromodulation devices for migraine and cluster headache (1 January 1990 to 31 January 2018), and 71 were identified. This analysis compared study designs using recommendations of the International Headache Society for pharmacological clinical trials, the only available guidelines for migraine and cluster headache. Non-invasive vagus nerve stimulation (nVNS), single-transcranial magnetic stimulation and external trigeminal nerve stimulation (all with regulatory clearance) were well studied compared with the other devices, for which studies frequently lacked proper blinding, sham controls and sufficient population sizes. nVNS studies demonstrated the most consistent adherence to available guidelines. Studies of all neuromodulation devices should strive to achieve the same high level of scientific rigour to allow for proper comparison across devices. Device-specific guidelines for migraine and cluster headache will be soon available, but adherence to current guidelines for pharmacological trials will remain a key consideration for investigators and clinicians.
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spelling pubmed-65852642019-07-05 Non-invasive neuromodulation for migraine and cluster headache: a systematic review of clinical trials Reuter, Uwe McClure, Candace Liebler, Eric Pozo-Rosich, Patricia J Neurol Neurosurg Psychiatry Migraine Non-invasive neuromodulation therapies for migraine and cluster headache are a practical and safe alternative to pharmacologics. Comparisons of these therapies are difficult because of the heterogeneity in study designs. In this systematic review of clinical trials, the scientific rigour and clinical relevance of the available data were assessed to inform clinical decisions about non-invasive neuromodulation. PubMed, Cochrane Library and ClinicalTrials.gov databases and the WHO’s International Clinical Trials Registry Platform were searched for relevant clinical studies of non-invasive neuromodulation devices for migraine and cluster headache (1 January 1990 to 31 January 2018), and 71 were identified. This analysis compared study designs using recommendations of the International Headache Society for pharmacological clinical trials, the only available guidelines for migraine and cluster headache. Non-invasive vagus nerve stimulation (nVNS), single-transcranial magnetic stimulation and external trigeminal nerve stimulation (all with regulatory clearance) were well studied compared with the other devices, for which studies frequently lacked proper blinding, sham controls and sufficient population sizes. nVNS studies demonstrated the most consistent adherence to available guidelines. Studies of all neuromodulation devices should strive to achieve the same high level of scientific rigour to allow for proper comparison across devices. Device-specific guidelines for migraine and cluster headache will be soon available, but adherence to current guidelines for pharmacological trials will remain a key consideration for investigators and clinicians. BMJ Publishing Group 2019-07 2019-03-01 /pmc/articles/PMC6585264/ /pubmed/30824632 http://dx.doi.org/10.1136/jnnp-2018-320113 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Migraine
Reuter, Uwe
McClure, Candace
Liebler, Eric
Pozo-Rosich, Patricia
Non-invasive neuromodulation for migraine and cluster headache: a systematic review of clinical trials
title Non-invasive neuromodulation for migraine and cluster headache: a systematic review of clinical trials
title_full Non-invasive neuromodulation for migraine and cluster headache: a systematic review of clinical trials
title_fullStr Non-invasive neuromodulation for migraine and cluster headache: a systematic review of clinical trials
title_full_unstemmed Non-invasive neuromodulation for migraine and cluster headache: a systematic review of clinical trials
title_short Non-invasive neuromodulation for migraine and cluster headache: a systematic review of clinical trials
title_sort non-invasive neuromodulation for migraine and cluster headache: a systematic review of clinical trials
topic Migraine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585264/
https://www.ncbi.nlm.nih.gov/pubmed/30824632
http://dx.doi.org/10.1136/jnnp-2018-320113
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