Single-Pulse Transcranial Magnetic Stimulation for the preventive treatment of difficult-to-treat migraine: a 12-month prospective analysis

• Published in: Journal of headache and pain 2022-06, Vol.23 (1), p.63-63, Article 63
• Main Authors: Lloyd, J.O., Hill, B., Murphy, M., Al-Kaisy, A., Andreou, A. P., Lambru, G.
• Format: Article
• Language: English
• Subjects: Adult; Chronic migraine; Disease prevention; Headache; Headache - etiology; Headache Disorders, Secondary - etiology; Headaches; Humans; Internal Medicine; Magnetic fields; Medicine; Medicine & Public Health; Migraine; Migraine Disorders - drug therapy; Migraine Disorders - prevention & control; Neurology; Neuromodulation; Non-invasive neuromodulation; Pain Medicine; Patients; Prospective Studies; Refractory migraine; Research Article; Scalp; Transcranial Magnetic Stimulation; Treatment Outcome
• ISSN: 1129-2369; 1129-2377
• DOI: 10.1186/s10194-022-01428-6

Background Initial evidence have shown the short-term efficacy of sTMS in the acute and preventive treatment of migraine. It is unknown whether this treatment approach in the long-term is effective and well tolerated in difficult-to-treat migraine. Methods This is a prospective, single centre, open-label, real-world analysis conducted in difficult-to-treat patients with high-frequency episodic migraine (HFEM) and chronic migraine (CM) with and without medication overuse headache (MOH), who were exposed to sTMS therapy. Patients responding to a three-month sTMS treatment, continued the treatment and were assessed again at month 12. The cut-off outcome for treatment continuation was reduction in the monthly moderate to severe headache days (MHD) of at least 30% (headache frequency responders) and/or a ≥ 4-point reduction in headache disability using the Headache Impact test-6 (HIT-6) (headache disability responders). Results One hundred fifty-three patients were included in the analysis (F:M = 126:27, median age 43, IQR 32.3–56.8). At month 3, 93 out of 153 patients (60%) were responders to treatment. Compared to baseline, the median reduction in monthly headache days (MHD) for all patients at month 3 was 5.0 days, from 18.0 (IQR: 12.0–26.0) to 13.0 days (IQR: 5.75–24.0) ( P  = 0.002, r  = − 0.29) and the median reduction in monthly migraine days (MMD) was 4.0 days, from 13.0 (IQR: 8.75–22.0) to 9.0 (IQR: 4.0–15.25) ( P  = 0.002, r  = − 0.29). Sixty-nine out of 153 patients (45%) reported a sustained response to sTMS treatment at month 12. The percentage of patients with MOH was reduced from 52% ( N  = 79/153) at baseline to 19% ( N  = 29/153) at month 3, to 8% ( N  = 7/87) at month 12. There was an overall median 4-point reduction in HIT-6 score, from 66 (IQR: 64–69) at baseline to 62 at month 3 (IQR: 56–65) ( P