Effectiveness and Safety of Noninvasive Neuromodulation for Migraine Prevention: A Network Meta‐Analysis
Abstract
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.
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.
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.
Among the noninvasive neuromodulation interventions discussed, PMES appears to be a…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 2,347 participants or records.
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