Response Predictors of Repetitive Neuromuscular Magnetic Stimulation in the Preventive Treatment of Episodic Migraine

Abstract

BackgroundRepetitive neuromuscular magnetic stimulation (rNMS) of the trapezius muscles showed beneficial effects in preventing episodic migraine. However, clinical characteristics that predict a favorable response to rNMS are unknown. The objective of this analysis is to identify such predictors.MethodsThirty participants with a diagnosis of episodic migraine (mean age: 24.8 ± 4.0 years, 29 females), who were prospectively enrolled in two non-sham-controlled studies evaluating the effects of rNMS were analyzed. In these studies, the interventional stimulation of the bilateral trapezius muscles was applied in six sessions and distributed over two consecutive weeks. Baseline and follow-up assessments included the continuous documentation of a headache calendar over 30 days before and after the stimulation period, the Migraine Disability Assessment Score (MIDAS) questionnaire (before stimulation and 90 days after stimulation), and measurements of pain pressure thresholds (PPTs) above the trapezius muscles by algometry (before and after each stimulation session). Participants were classified as responders based on a ≥25% reduction in the variable of interest (headache frequency, headache intensity, days with analgesic intake, MIDAS score, left-sided PPTs, right-sided PPTs). Post-hoc univariate and multivariate binary logistic regression analyses were performed.ResultsLower headache frequency (P = 0.016) and intensity at baseline (P = 0.015) and a migraine diagnosis without a concurrent tension-type headache component (P = 0.011) were significantly related to a ≥25% reduction in headache frequency. Higher headache frequency (P = 0.052) and intensity at baseline (P = 0.014) were significantly associated with a ≥25% reduction in monthly days with analgesic intake. Lower right-sided PPTs at baseline were significantly related to a ≥25% increase in right-sided PPTs (P = 0.0.015) and left-sided PPTs (P =0.030). Performance of rNMS with higher stimulation intensities was significantly associated with a ≥25% reduction in headache intensity (P = 0.046).ConclusionsClinical headache characteristics at baseline, the level of muscular hyperalgesia, and stimulation intensity may inform about how well an individual patient responds to rNMS. These factors may allow an early identification of patients that would most likely benefit from rNMS.

Neuromodulation in Pediatric Migraine using Repetitive Neuromuscular Magnetic Stimulation: A Feasibility Study

“…Similar findings have also been reported in previous studies investigating rNMS in young adults with episodic migraine (reduction in headache frequency from 7.7 (5.7-12) to 5.3 (1.7-10.3) days/month [median (range)] and 7.7 ± 6.9 to 5.1 ± 4.8 days/month [mean ± SD]; reduction in medication intake from 4 (0-9.7) to 3 (0-9) days/month [median (range)] and 3.3 ± 2.8 to 2.8 ± 1.8 days/month [mean ± SD]) [33,35]. Moreover, a retrospective analysis of the pooled data of both studies showed similar developments, too (reduction in headache frequency from 8.17 ± 4.50 to 6.33 ± 4.38 days/month [mean ± SD], reduction in medication intake from 3.63 ± 2.58 to 3.10 ± 2.44 days/month [mean ± SD]) [50].…”

“…With regard to headache-related disability, a significant reduction in MIDAS scores was reported after rNMS in adults with episodic migraine in previous studies (MIDAS Score reduction from 26.33 ± 13.89 to 15.37 ± 12.30 [mean ± [50]. In congruence, in the current first ever report on the impact of rNMS to the burden of migraine, PedMIDAS scores decreased on average by 14.33 units from baseline to FU, which corresponds to a reduction of 40.9%.…”

Functional magnetic resonance imaging in migraine: A systematic review

“…Aside from acupuncture, neuromodulatory therapeutic approaches have been investigated in different forms. While studies have investigated taVNS, RAVANS, and eTNS, many other neuromodulatory bottom-up approaches exist for migraine treatment (e.g., exploiting the trigemino-cervical complex by performing peripheral muscular stimulation to alleviate headache symptoms [151,[163][164][165][166][167]), for which fMRI investigations currently appear to be lacking. Here, fMRI could potentially help to elucidate central mechanisms of action.…”

Migraine: from pathophysiology to treatment

“…A recent open-label study showed preliminary evidence supporting its use in chronic migraine [ 222 ]. Finally, repetitive peripheral magnetic stimulation (rPMS) targeting the muscles in the neck and shoulder muscles has shown efficacy in the prevention of episodic migraine, particularly in patients with a high level of muscular involvement [ 223 , 224 ].…”