Background

Non-invasive vagus nerve stimulation (nVNS) is a proven treatment for cluster headache and migraine. Several possible mechanisms of action by which nVNS mitigates headache have been identified.

Methods

We conducted a narrative review of recent scientific and clinical research into nVNS for headache, including findings from mechanistic studies and their possible relationships to the clinical effects of nVNS.

Results

Findings from animal and human studies have provided possible mechanistic explanations for nVNS efficacy in headache involving four core areas: Autonomic nervous system functions; cortical spreading depression inhibition; neurotransmitter regulation; and nociceptive modulation. We discuss how overlap and interplay among these areas may underlie the utility of nVNS in the context of clinical evidence supporting its safety and efficacy as acute and preventive therapy for both cluster headache and migraine. Possible future nVNS applications are also discussed.

Conclusion

Significant progress over the past several years has yielded valuable mechanistic and clinical evidence that, combined with the excellent safety and tolerability profile of nVNS, suggests that it should be considered a first-line treatment for both acute and preventive treatment of cluster headache, an effective option for acute treatment of migraine, and a highly relevant, practical option for migraine prevention.

中文翻译：

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原发性头痛的非侵入性迷走神经刺激：临床更新。

背景

非侵入性迷走神经刺激 (nVNS) 是一种行之有效的治疗丛集性头痛和偏头痛的方法。已经确定了 nVNS 减轻头痛的几种可能的作用机制。

方法

我们对最近关于 nVNS 头痛的科学和临床研究进行了叙述性审查，包括机械研究的结果及其与 nVNS 临床效果的可能关系。

结果

动物和人类研究的结果为 nVNS 在头痛中的功效提供了可能的机制解释，涉及四个核心领域：自主神经系统功能；皮质扩散抑制；神经递质调节；和伤害感受调制。我们讨论了这些领域之间的重叠和相互作用如何在临床证据支持其作为丛集性头痛和偏头痛的急性和预防性治疗的安全性和有效性的背景下成为 nVNS 效用的基础。还讨论了未来可能的 nVNS 应用。

结论

过去几年的重大进展已经产生了宝贵的机制和临床证据，结合 nVNS 出色的安全性和耐受性，表明它应该被视为丛集性头痛急性和预防性治疗的一线治疗，一种有效的治疗方法。偏头痛急性治疗的一种选择，也是一种高度相关、实用的偏头痛预防选择。