Transcranial magnetic stimulation for migraine with medication overuse headache

Transcranial magnetic stimulation (TMS) was approved by the FDA at the end of 2013 (see my earlier post) but it has not yet become available. This approval was for the treatment of acute migraine.

A new study just presented at the International Headache Congress suggests that TMS could be effective for the preventive treatment of migraines with medication overuse headache.

The study included only 28 patients and it was not a blinded study. However, these patients were severely affected and failed several other treatments. They were instructed to use the TMS device twice a day every day with an additional treatment at the time of a headache. Treatment lasted for at least 3 months, with an option to continue for another 3 months.

Of the 28 patients, 24 (86%) reported a reduction in their days of acute medication use per month, while 2 patients reported an increase in acute medication use. Nineteen patients (68%) experienced fewer migraine days per month, and 7 of the 19 had a 50% or greater reduction in migraine days. The number of patients with pain severity rated as excruciating or severe dropped from 19 at baseline to 3 at 3 months (84% reduction). Headache attack duration decreased in 15 patients, remained unchanged in 9, and increased in 4. The disability score (HIT-6) was severe at the beginning of the study in 26 of 28 participants. After 3 months, only 18 had severe disability.

The benefit was seen in patients who had migraines with and without aura.

After 3 months, five patients stopped using TMS because it was ineffective or inconvenient. Four were lost to follow-up. Of the remaining 19, 16 reported reduced days of acute medication use at 6 months, compared with baseline. Disability scores in the 19 patients who used TMS for 6 months were comparable to their scores at 3 months, suggesting that there was no additional benefit from longer-term use, but the benefit was maintained.

No side effects were reported, confirming the safety of TMS. Now we just have to wait for the company (eNeura) to release this product on the market.

  1. Dr. Mauskop says: 01/01/20172:01 pm

    According to the manufacturer, it can take up to a couple of months of daily use to see the benefit of TMS on chronic migraines. So far, only a small number of our patients have used it and my impression is that it works for one out of three patients. Of course, my impression is likely to be inaccurate because of the small number of patients, some of whom did not persist in using TMS long enough to experience any benefits. Also, most of our patients who’ve tried eNeura TMS have tried and failed many prophylactic medications and Botox injections, so it is likely that TMS is more effective for people with less refractory migraines.

  2. Ellen says: 12/31/201611:50 pm

    I just found this post as I was searching your site for anything related to TMS. I received my eNeura TMS unit last week and have used it twice since then. The first time it seemed to have no benefit but the second time it seemed to help. There are so many variables with each headache that it will take time to ascertain if the TMS unit is actually beneficial. But I am encouraged by the study you describe in this post. Thank you for staying up to date with the latest treatment options for those of us with chronic migraine.

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