蝶腭神经节阻滞
蝶腭神经节 (SPG) 是一组神经细胞，与三叉神经相连，位于鼻后侧。已证实通过鼻内手段（通过连接至含有如布比卡因等麻醉剂的注射器）阻滞 SPG 对于偏头痛和丛集性头痛的急性治疗有一定疗效。已为丛集性头痛的治疗开发了新的 SPG 刺激设备。很少有研究证明这一方法在治疗慢性偏头痛中具有疗效。[282]Ho KWD, Przkora R, Kumar S. Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review. J Headache Pain. 2017 Dec 28;18(1):118.https://link.springer.com/article/10.1186/s10194-017-0826-yhttp://www.ncbi.nlm.nih.gov/pubmed/29285576?tool=bestpractice.com[283]Cady RK, Saper J, Dexter K, et al. Long-term efficacy of a double-blind, placebo-controlled, randomized study for repetitive sphenopalatine blockade with bupivacaine vs. saline with the Tx360 device for treatment of chronic migraine. Headache. 2015 Apr;55(4):529-42.https://onlinelibrary.wiley.com/doi/full/10.1111/head.12546http://www.ncbi.nlm.nih.gov/pubmed/25828648?tool=bestpractice.com[284]Mojica J, Mo B, Ng A. Sphenopalatine ganglion block in the management of chronic headaches. Curr Pain Headache Rep. 2017 Jun;21(6):27. Erratum in: Curr Pain Headache Rep. 2017 Nov;21(12 ):53.https://link.springer.com/article/10.1007%2Fs11916-017-0626-8http://www.ncbi.nlm.nih.gov/pubmed/28432602?tool=bestpractice.com
经颅磁刺激
在美国（2015 年）和英国，经颅磁刺激 (TMS) 已被批准用于治疗急性偏头痛。 安慰剂对照试验和上市后数据支持将其用于治疗各种发作性偏头痛。[285]Bhola R, Kinsella E, Giffin N, et al. Single-pulse transcranial magnetic stimulation (sTMS) for the acute treatment of migraine: evaluation of outcome data for the UK post market pilot program. J Headache Pain. 2015;16:535.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463955/http://www.ncbi.nlm.nih.gov/pubmed/26055242?tool=bestpractice.com[286]Lipton RB, Dodick DW, Silberstein SD, et al. Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: a randomised, double-blind, parallel-group, sham-controlled trial. Lancet Neurol. 2010 Apr;9(4):373-80.http://www.ncbi.nlm.nih.gov/pubmed/20206581?tool=bestpractice.com TMS 显得很安全，没有严重不良事件报道。该疗法是非侵入性的，无药物相互作用，意在由患者在家使用。其效果似乎类似于“曲坦类药物”，但目前没有比较 TMS 与药物治疗的头对头试验。不建议植入电子设备的患者使用 TMS。
褪黑激素
已证明松果腺不正常是引起偏头痛的原因之一，研究已显示偏头痛患者中分泌的褪黑激素水平较低。 褪黑激素分泌异常可能指示存在更加普遍的神经障碍，或可能影响 CGRP 调节。 数项研究已发现褪黑激素可减轻偏头痛患者的疼痛且几乎无副作用，但需要更大规模的临床试验以确定其效用。[287]Vogler B, Rapoport AM, Tepper SJ, et al. Role of melatonin in the pathophysiology of migraine: implications for treatment. CNS Drugs. 2006;20(5):343-50.http://www.ncbi.nlm.nih.gov/pubmed/16696576?tool=bestpractice.com[288]Peres MF, Masruha MR, Zukerman E, et al. Potential therapeutic use of melatonin in migraine and other headache disorders. Expert Opin Investig Drugs. 2006 Apr;15(4):367-75.http://www.ncbi.nlm.nih.gov/pubmed/16548786?tool=bestpractice.com[289]Gagnier JJ. The therapeutic potential of melatonin in migraines and other headache types. Altern Med Rev. 2001 Aug;6(4):383-9.http://www.ncbi.nlm.nih.gov/pubmed/11578254?tool=bestpractice.com 一项随机对照临床试验发现，在预防偏头痛方面，褪黑素与阿米替林一样有效。这两种治疗均明显优于安慰剂。褪黑素治疗组的副作用显著较少。[290]Gonçalves AL, Martini Ferreira A, Ribeiro RT, et al. Randomised clinical trial comparing melatonin 3 mg, amitriptyline 25 mg and placebo for migraine prevention. J Neurol Neurosurg Psychiatry. 2016 Oct;87(10):1127-32.http://jnnp.bmj.com/content/87/10/1127.longhttp://www.ncbi.nlm.nih.gov/pubmed/27165014?tool=bestpractice.com
米氮平
这种抗抑郁剂可有效治疗和预防偏头痛发作，但是作用机制仍未知，且至今为止，效益证据仅见于病例报告。 需要进一步研究评估此治疗。[291]Levy E, Margolese HC. Migraine headache prophylaxis and treatment with low dose mirtazapine. Int Clin Psychopharmacol. 2003 Sep;18(5):301-3.http://www.ncbi.nlm.nih.gov/pubmed/12920393?tool=bestpractice.com
血管紧张素拮抗剂
已考虑使用抑制血管收缩的不同药物治疗偏头痛。 数项小型临床试验中已显示血管紧张素-II 受体拮抗剂坎地沙坦和奥美沙坦以及血管紧张素转换酶抑制剂赖诺普利会减少偏头痛发作的频率和严重程度，在患有偏头痛和心血管疾病且可能无法服用曲普坦的患者中这些药物可能尤为有用。[228]Loder E, Biondi D. Can this patient take a triptan? Review of the cardiovascular safety of the triptans and recommendations for patient selection and evaluation. Internet J Neurol. 2004;3:1-15.https://ispub.com/IJN/3/1/9243[229]White WB, Derosier FJ, Thompson AH, et al. Evaluation of the migraine treatment sumatriptan/naproxen sodium on blood pressure following long-term administration. J Clin Hypertens. 2011 Dec;13(12):910-6.http://onlinelibrary.wiley.com/doi/10.1111/j.1751-7176.2011.00554.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/22142350?tool=bestpractice.com 不过，还需要更多证据来确定它们对治疗和预防偏头痛的效果。[292]Charles JA, Jotkowitz S, Byrd LH. Prevention of migraine with olmesartan in patients with hypertension/prehypertension. Headache. 2006 Mar;46(3):503-7.http://www.ncbi.nlm.nih.gov/pubmed/16618270?tool=bestpractice.com[293]Owada K. Efficacy of candesartan in the treatment of migraine in hypertensive patients. Hypertens Res. 2004 Jun;27(6):441-6.https://www.jstage.jst.go.jp/article/hypres/27/6/27_6_441/_pdf/-char/enhttp://www.ncbi.nlm.nih.gov/pubmed/15253110?tool=bestpractice.com[294]Tronvik E, Stovner LJ, Helde G, et al. Prophylactic treatment of migraine with an angiotensin II receptor blocker: a randomized controlled trial. JAMA. 2003 Jan 1;289(1):65-9.http://jama.ama-assn.org/cgi/content/full/289/1/65http://www.ncbi.nlm.nih.gov/pubmed/12503978?tool=bestpractice.com[295]Modi S, Lowder DM. Medications for migraine prophylaxis. Am Fam Physician. 2006 Jan 1;73(1):72-8.http://www.aafp.org/afp/20060101/72.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/16417067?tool=bestpractice.com[296]Gales BJ, Bailey EK, Reed AN, et al. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for the prevention of migraines. Ann Pharmacother. 2010 Feb;44(2):360-6.http://www.ncbi.nlm.nih.gov/pubmed/20086184?tool=bestpractice.com
经口吸入性双氢麦角胺
与肌内和鼻内给药相比，双氢麦角胺（一种麦角生物碱）吸入剂可为偏头痛患者提供该治疗更为便捷的给药途径，且给药情况更为一致。一项随机对照试验显示，作为有先兆或无先兆偏头痛患者的紧急治疗，与安慰剂相比，吸入用双氢麦角胺更为有效且耐受性良好。[297]Aurora SK, Silberstein SD, Kori SH, et al. MAP0004, orally inhaled DHE: a randomized, controlled study in the acute treatment of migraine. Headache. 2011 Apr;51(4):507-17.http://www.ncbi.nlm.nih.gov/pubmed/21457235?tool=bestpractice.com
舒马曲坦鼻内吸粉剂
通过呼吸动力鼻内给药系统给药的舒马曲坦粉末新制剂现在可在部分国家/地区商购，包括美国。 在比较试验中，该鼻内吸粉剂在使用后 15 分钟即缓解或改善疼痛，显著快于舒马曲坦片剂。[298]Tepper SJ, Cady RK, Silberstein S, et al. AVP-825 breath-powered intranasal delivery system containing 22 mg sumatriptan powder vs 100 mg oral sumatriptan in the acute treatment of migraines (The COMPASS study): a comparative randomized clinical trial across multiple attacks. Headache. 2015 May;55(5):621-35.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4682470/http://www.ncbi.nlm.nih.gov/pubmed/25941016?tool=bestpractice.com
经皮舒马曲坦
经皮离子导入系统已在一些国家可用。 认为此系统有效且耐受性良好，可能在出现胃肠症状的患者中有用。[299]Goldstein J, Smith TR, Pugach N, et al. A sumatriptan iontophoretic transdermal system for the acute treatment of migraine. Headache. 2012 Oct;52(9):1402-10.http://www.ncbi.nlm.nih.gov/pubmed/22694484?tool=bestpractice.com 然而，有报告称使用该贴剂的用药部位出现了皮肤灼伤和瘢痕形成，因此，2016 年 6 月，美国食品药品监督管理局要求暂停使用该药。[300]US Food and Drug Administration. Zecuity (sumatriptan) migraine patch: drug safety communication - FDA evaluating risk of burns and scars. June 2016 [internet publication].https://www.fda.gov/drugs/drugsafety/ucm504588.htm
辛伐他汀和维生素 D
将辛伐他汀和维生素 D 与安慰剂进行对照的单次随机双盲试验发现，辛伐他汀和维生素 D 组的头痛频率显著降低。 虽然前景较好，但是对辛伐他汀可能造成不良事件的担忧可能会限制患者接受该疗法。[301]Buettner C, Nir RR, Bertisch SM, et al. Simvastatin and vitamin D for migraine prevention: a randomized, controlled trial. Ann Neurol. 2015 Dec;78(6):970-81.http://www.ncbi.nlm.nih.gov/pubmed/26418341?tool=bestpractice.com
适用于偏头痛治疗的脉冲射频消融术
已有人建议，将枕大神经阻滞术和枕大神经脉冲射频消融术作为偏头痛的治疗方法。 单一随机试验支持使用枕大神经脉冲射频消融术治疗偏头痛。[302]Cohen SP, Peterlin BL, Fulton L, et al. Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness. Pain. 2015 Dec;156(12):2585-94.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4697830/http://www.ncbi.nlm.nih.gov/pubmed/26447705?tool=bestpractice.com
