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

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.