Single-pulse transcranial magnetic stimulation for migraine with aura beneficial

January 01, 0001

Single-pulse transcranial magnetic stimulation for migraine with aura beneficial

Preliminary work suggests that single-pulse transcranial magnetic stimulation (sTMS) could be effective as a treatment for migraine. The researchers from the USA aimed to assess the efficacy and safety of a new portable sTMS device for acute treatment of migraine with aura. They undertook a randomised, double-blind, parallel-group, two-phase, sham-controlled study at 18 centres in the USA. 267 adults aged 18—68 years were enrolled into phase one. All individuals had to meet international criteria for migraine with aura, with visual aura preceding at least 30% of migraines followed by moderate or severe headache in more than 90% of those attacks. 66 patients dropped out during phase one. In phase two, 201 individuals were randomly allocated by computer to either sham stimulation (n=99) or sTMS (n=102). They instructed participants to treat up to three attacks over 3 months while experiencing aura. 164 patients treated at least one attack with sTMS (n=82) or sham stimulation (n=82, modified intention-to-treat analysis set).

Pain-free response rates after 2 h were significantly higher with sTMS (39%) than with sham stimulation (22%), for a therapeutic gain of 17%. Sustained pain-free response rates significantly favoured sTMS at 24 h and 48 h post- treatment. Non-inferiority was shown for nausea, photophobia, and phonophobia. No device-related serious adverse events were recorded, and incidence and severity of adverse events were similar between sTMS and sham groups.

The researchers concluded: "Early treatment of migraine with aura by sTMS resulted in increased freedom from pain at 2 h compared with sham stimulation, and absence of pain was sustained 24 h and 48 h after treatment. sTMS could be a promising acute treatment for some patients with migraine with aura."

As people need access to such therapy, will we see such a device in primary physician’s offices?

For the full abstract, click here.

The Lancet Neurology 9(4): 373-380, April 2010 © 2010 Elsevier Ltd
Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: a randomised, double-blind, parallel-group, sham-controlled trial. Richard B Lipton, David W Dodick, Stephen D Silberstein et al. Correspondence to Richard Lipton: [email protected]

Category: N. Neurological. Keywords: single pulse, transcranial, magnetic, stimulation, acute, treatment, migraine, aura, randomised, double blind, parallel group, sham controlled trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 30 April 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.