Repetitive transcranial magnetic stimulation in chronic tension-type headache: A pilot study

Abstract

Background & objectives:Tension-type headache (TTH) is the most common type of primary headache disorder. Its chronic form is often the most ignored and challenging to treat. Transcranial magnetic stimulation (TMS) is a novel technique in the treatment of chronic pain. The aim of this pilot study was to explore the effect of low-frequency repetitive TMS (rTMS) on pain status in chronic TTH (CTTH) by subjective and objective pain assessment.Methods:Patients (n=30) diagnosed with CTTH were randomized into rTMS (n=15) and placebo (n=15) groups in this study. Pre-intervention detailed history of patients was taken. Numerical Rating Scale (NRS) for Pain and questionnaires [Headache Impact Test-6 (HIT-6), McGill Pain Questionnaire, Pain Beliefs Questionnaire, Coping Strategies Questionnaire, State-Trait Anxiety Inventory Test, Hamilton Rating Scale for Depression and WHO-Quality of Life Questionnaire-Brief version] were filled, and objective assessments such as nociceptive flexion reflex (NFR) and conditioned pain modulation were done. The tests were repeated after 20 sessions (5 days/week). In the rTMS group, 1200 pulses in eight trains of 150 pulses each were given at 1Hz over the right dorsolateral prefrontal cortex (RDLPFC). In the placebo group, the rTMS coil was placed such that magnetic stimulation did not reach the cortex.Results:The NRS score decreased significantly (P<0.001) and NFR thresholds increased significantly (P=0.011) in the rTMS group when compared to placebo group.Interpretation & conclusions:Subjective improvements in the NRS, HIT-6, McGill Present Pain Intensity, trait of anxiety and psychological pain beliefs were observed. The increase in the thresholds of NFR served as an objective marker for improvement in pain status. Further studies need to be done to confirm our preliminary findings.

The effectiveness of botulinum toxin for chronic tension-type headache prophylaxis: A systematic review and meta-analysis

“…Articles that were excluded in the full-text screening are summarized in online Supplementary Table S3. Twenty-two interventional trials on the effects of BTX-A on CTTH met eligibility and were included (39–60). The studies collectively exposed 652 patients with CTTH to BTX-A.…”

Modulation of the nociceptive flexion reflex by conservative therapy in patients and healthy people: a systematic review and meta-analysis

“…Seven studies exclusively examined patients with a disorder, ie, fibromyalgia (FM), 5,82 chronic low back pain, 14 chronic whiplash–associated disorders, 79 diabetic neuropathy, 63 chronic tension–type headache, 55 and multiple sclerosis (MS). 8 Study participants were healthy adults in 27 studies.…”

“…8 Three studies showed that rTMS induced a significant NFR inhibition in patient populations. Indeed, rTMS over the DLPFC increased the NFR threshold in patients with chronic tension-type headache and FM, 55,82 and rTMS over the M1 decreased the NFR area in patients with diabetic neuropathy. 63 Remarkably, the study in FM patients was not able to demonstrate inhibitory effects on other NFR parameters (ie, latency, duration, and amplitude).…”

“…Supplemental Table S4a (available at http://links.lww.com/PAIN/ B514) gives an overview of the conservative treatment interventions included in the present review. The effects of non-invasive neuromodulation on the NFR were frequently studied using TENS in 5 studies, 14,19,34,81,88 interferential therapy (IFT) in 1 study, 19 DCS in 5 studies, 8,16,24,47,64 TMS in 7 studies, 53,55,57,58,60,63,82 transspinal DCS or rTMS combined with treadmill walking in 1 study, 1 noninvasive vagal nerve stimulation (nVNS) in 2 studies, 2,22 and piezo-electric current (PEC) in 1 study. 21 The effects of biofeedback training on the NFR were examined in 5 studies.…”

“…6,19,20,31,44,49,71,72,88 Nineteen studies 1,2,6,8,16,18,21,22,24,47,49,53,57,58,60,63,64,69,82 applied a sham intervention, and placebo therapies were administered in 5 studies. 14,34,55,79,81 Two studies examining the effects of pain catastrophizing reduction on the NFR used pain education as a control intervention. 83,84 One study compared the effects of CBT relative to usual care.…”