Effectiveness and Safety of Noninvasive Neuromodulation for Migraine Prevention: A Network Meta-Analysis

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Acta Neurologica Scandinavica Pub Date : 2026-03-26 DOI:10.1155/ane/7971285

Quan Feng, Fang Liu, Na Li, Xiran Yu, Lu Ning, Yichen Li, Ge Tan

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Abstract

Background

Migraine, a common chronic neurovascular disorder, has a global incidence rate of approximately 14%. Limited evidence exists for clinical decision-making related to migraine preventive treatment via noninvasive neuromodulation. To bridge this gap, we conducted a network meta-analysis (NMA) aimed at comparing and ranking the efficacy and safety of diverse noninvasive neuromodulation treatments in preventing migraine.

Methods

We systematically searched for randomized controlled trials (RCTs) in four databases and included the final articles through strict screening. Subsequently, we carried out data extraction and quality assessment. Then, an NMA (PROSPERO ID CRD42024617371) based on the frequentist model was performed. Finally, we drew conclusions based on the surface under the cumulative ranking curve (SUCRA) and the league table.

Results

Twenty four RCTs involving 2347 patients were included. Although no modality significantly reduced monthly migraine days versus placebo (p > 0.05), percutaneous mastoid electrical stimulation (PMES) emerged as the most effective and safest intervention (SUCRA: 78.8%) compared with placebo in achieving a 50% responder rate (OR = 16.58, 95% CI: 5.17, 53.17) and reducing monthly acute antimigraine medication use (MD = −0.90, 95% CI: −1.28, −0.52). Noninvasive vagus nerve stimulation (nVNS) exhibited the best safety profile (SUCRA: 72.2%) when high-risk trials were excluded.

Conclusion

Among the noninvasive neuromodulation interventions discussed, PMES appears to be a favorable choice for migraine prevention, pending verification through cross-regional investigations. And nVNS shows the best safety profile when high-risk trials were excluded.

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无创神经调节预防偏头痛的有效性和安全性：一项网络荟萃分析

偏头痛是一种常见的慢性神经血管疾病，全球发病率约为14%。通过无创神经调节进行偏头痛预防治疗的临床决策证据有限。为了弥补这一差距，我们进行了一项网络荟萃分析（NMA），旨在比较和排名各种非侵入性神经调节治疗在预防偏头痛方面的有效性和安全性。方法系统检索4个数据库的随机对照试验（rct），通过严格筛选纳入最终文章。随后，我们进行了数据提取和质量评估。然后，进行了基于频域模型的NMA （PROSPERO ID CRD42024617371）。最后，根据累积排名曲线（SUCRA）和排名表下的曲面得出结论。结果共纳入24项随机对照试验，共2347例患者。虽然与安慰剂相比，没有任何一种治疗方式能显著减少每月偏头痛天数（p > 0.05），但与安慰剂相比，经皮乳突电刺激（PMES）是最有效和最安全的干预措施（SUCRA: 78.8%），达到50%的缓解率（OR = 16.58, 95% CI: 5.17, 53.17），并减少每月急性抗偏头痛药物的使用（MD = - 0.90, 95% CI: - 1.28, - 0.52）。当排除高风险试验时，无创迷走神经刺激（nVNS）表现出最佳的安全性（SUCRA: 72.2%）。结论在讨论的非侵入性神经调节干预措施中，PMES似乎是预防偏头痛的有利选择，有待跨区域研究的验证。当排除高风险试验时，nVNS显示出最佳的安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Neurologica Scandinavica 医学-临床神经学

CiteScore

6.70

自引率

2.90%

发文量

161

审稿时长

4-8 weeks

期刊介绍： Acta Neurologica Scandinavica aims to publish manuscripts of a high scientific quality representing original clinical, diagnostic or experimental work in neuroscience. The journal''s scope is to act as an international forum for the dissemination of information advancing the science or practice of this subject area. Papers in English will be welcomed, especially those which bring new knowledge and observations from the application of therapies or techniques in the combating of a broad spectrum of neurological disease and neurodegenerative disorders. Relevant articles on the basic neurosciences will be published where they extend present understanding of such disorders. Priority will be given to review of topical subjects. Papers requiring rapid publication because of their significance and timeliness will be included as ''Clinical commentaries'' not exceeding two printed pages, as will ''Clinical commentaries'' of sufficient general interest. Debate within the speciality is encouraged in the form of ''Letters to the editor''. All submitted manuscripts falling within the overall scope of the journal will be assessed by suitably qualified referees.