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Non-invasive vagus nerve stimulation (nVNS) is an effective treatment for migraine patients.
The conclusion of
the study states that acute nVNS treatment is beneficial in reducing pain
intensity consistently with a decrease in the use of rescue medication.
Non-invasive vagus nerve stimulation (nVNS) is
an effective treatment for migraine patients. It is a flexible, practical and
easy to use the technique with reduced risk of drug-drug interactions. These
advantages allow the use of nVNS as a complementary treatment option to
existing migraine therapies. It also reduces the need for pharmacologic
therapies and their associated side effects in the treatment of migraine. The
PRESTO trial provided class I evidence for the use of nVNS in patients with
episodic migraine. The study demonstrated that nVNS significantly increases the
probability of having mild pain or being pain-free 2h post stimulation. nVNS
was superior to placebo for the majority of endpoints including pain relief,
pain freedom and ≥ 50% responder rates at different time points with the
incidence of minimal and mild adverse events.
Rationale
behind research:
The present post
hoc analysis has been conducted to provide further insight into the practical
use of acute nVNS treatment by reporting clinically relevant endpoints that
extend beyond the traditional parameters recommended by the International
Headache Society (IHS).
Objective:
The
present study focused on evaluating the likelihood of experiencing at least a
1-point decrease in pain intensity and assess the efficacy of nVNS when the
migraine pain is mild.
Study outcomes:
The study outcomes included evaluation of:
Time Points: 30, 60, and 120 min
Outcomes:
Baseline: There were
no significant differences observed at baseline
Study outcomes:
The present study indicated clinically essential benefits of nVNS as
an acute treatment of migraine. The likelihood that nVNS will reduce pain by at
least 1 point and the use of rescue medication highlights its favourable
risk-benefit profile. Reduction in the use of pharmacological therapies may
encourage patient adherence to nVNS with an opportunity to minimise the
potential limitations associated with traditional acute migraine medications
including adverse effects, medication overuse and drug-drug interactions. It
offered efficacy, flexibility and established safety & tolerability
encouraging its earlier use than conventional acute therapies. Pharmacological
treatments are demonstrated as beneficial and reserved for severe pain because
of issues such as medication-related tolerability and insufficient availability
of other acute medications. This analysis establishes the use of nVNS as a
practical and useful alternative that can be used frequently and early in an
attack to decrease migraine pain, need of rescue medication and drug-related
adverse effects.
NA
The present data highlight the clinical
importance of nVNS in the acute treatment of migraine. The clinical study
provides recommendations for the optimal use of nVNS in everyday practice, with
a reduction in the use of acute pharmacologic medications and their associated
adverse events.
The Journal of Headache and Pain. 2018; 19:98.
Practical and clinical utility of non-invasive vagus nerve stimulation (nVNS) for the acute treatment of migraine: a post hoc analysis of the randomized, sham-controlled, double-blind PRESTO trial
Grazzi et al.
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