Transcranial magnetic stimulation for treating and preventing migraine

A multicentre randomised controlled trial of 164 patients treated for at least 1 attack of migraine with aura with a handheld single transcranial magnetic stimulation (sTMS) device (n=82) or with sham stimulation (n=82) reported that pain-free rates 2 hours after stimulation were significantly better with sTMS (39% [32 out of 82]) than with sham stimulation (22% [18 out of 82]; p=0.018). Sustained pain-free response rates (with no recurrence and no rescue drug use) significantly favoured sTMS at 24 hours (29% [24 out of 82] versus 16% [13 out of 82]; p=0.0405) and 48 hours (27% [22 out of 82] versus 13% [11 out of 82]; p=0.0327) after treatment. There were no significant differences in secondary outcomes (headache response at 2 hours, use of rescue drugs, Migraine Disability Assessment [MIDAS] score and consistency of pain relief response) between groups.

A case series of 51 patients with 'medically resistant migraine' using repeated transcranial magnetic stimulation (rTMS) for prevention reported that 98% (50 out of 51) of patients had a greater than 50% reduction in headache frequency at the end of 1 week and the improvement persisted at follow-up of 4 weeks in 80.4% (41 out of 51) of patients. Headache frequency and severity, functional disability and use of rescue drugs were significantly reduced at all time points (1, 2, 3 and 4 weeks, p<0.0001) but the maximum benefit was observed in the first 2 weeks.

A case series of 27 patients with migraine comparing low-frequency rTMS (n=14) against sham stimulation (n=13) for prevention reported no significant difference between groups for any reported outcome (including number and duration of migraine attacks, mean pain intensity and use of analgesics). The 'within-group' findings showed a significant decrease in the number of migraine attacks during 8 weeks within the rTMS group from 9.36±2.82 attacks to 6.79±4.28 attacks (p=0.007), and a non-significant decrease within the sham group (numbers not reported; p=0.216). There was a significant reduction in migraine days during 8 weeks in both rTMS and sham groups (from 17.69±11.63 days to 13.15±9.27 days [p=0.012] and from 14.36±5.07 days to 9.50±6.80 days [p=0.006] respectively). The rTMS group showed a significant reduction in migraine hours during 8 weeks from 125.93±80.31 hours to 85.36±72.27 hours (p=0.035); the difference was not significant in the sham group (numbers not reported; p=0.080).

The specialist advisers listed additional efficacy outcomes as complete resolution of a migraine attack, reduction in headache severity, and improvement in associated symptoms, disability and quality of life.