An open-label observational study and meta-analysis of non-invasive vagus nerve stimulation in medically refractory chronic cluster headache

Autor: Lucy Simmonds, Susie Lagrata, Anker Stubberud, Sanjay Cheema, Erling Tronvik, Manjit Matharu, Salwa Kamourieh
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Frontiers in Neurology, Vol 14 (2023)
Druh dokumentu: article
ISSN: 1664-2295
DOI: 10.3389/fneur.2023.1100426
Popis: BackgroundMany patients with cluster headache (CH) are inadequately controlled by current treatment options. Non-invasive vagus nerve stimulation (nVNS) is reported to be effective in the management of CH though some studies suggest that it is ineffective.ObjectiveTo assess the safety and efficacy of nVNS in chronic cluster headache (CCH) patients.MethodWe prospectively analysed data from 40 patients with refractory CCH in this open-label, observational study. Patients were seen in tertiary headache clinics at the National Hospital for Neurology and Neurosurgery and trained to use nVNS as preventative therapy. Patients were reivewed at one month and then three-monthly from onset. The primary endpoint was number of patients achieving ≥50% reduction in attack frequency at 3 months. A meta-analysis of all published studies evaluating the efficacy of nVNS in CCH was also conducted. We searched MEDLINE and EMBASE for all studies investigating the use of nVNS as a preventive or adjunctive treatment for CCH with five or more participants. Combined mean difference and responder proportions with 95% confidence intervals (CI) were calculated from the included studies.Results17/40 patients (43%) achieved ≥50% reduction in attack frequency at 3 months. There was a significant reduction in monthly attack frequency from a baseline of 124 (±67) attacks to 79 (±63) attacks in month 3 (mean difference 44.7; 95% CI 25.1 to 64.3; p
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