Transcranial Magnetic and Direct Current Stimulation (TMS/tDCS) for the Treatment of Headache: A Systematic Review

Abstract

Background Headache is among the most prevalent causes of disability worldwide. Non‐pharmacologic interventions, including neuromodulation therapies, have been proposed in patients who are treatment resistant or intolerant to medications. Objective To perform a systematic review on the use of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) for the treatment of specific headache disorders (ie, migraine, tension, cluster, posttraumatic). Methods Data sources: Ovid MEDLINE, Cochrane Central Register of Clinical Trials, Embase, Scopus, PsycINFO. Data extraction: All references were reviewed by 2 independent researchers (3039 abstracts, duplicates removed). Records were selected by inclusion criteria for participants (adults 18‐65 with primary or secondary headaches), interventions (TMS and tDCS applied as headache treatment), comparators (sham or alternative standard of care), and study type (cohort, case‐control, and randomized controlled trials [RCT]). Studies were assessed using the Cochrane Risk of Bias Tool and overall quality determined through the GRADE Tool. A structured synthesis was performed due to heterogeneity of participants and methods. Results Thirty‐four studies were included: 16 rTMS, 6 TMS (excluding rTMS), and 12 tDCS. The majority investigated treatment for migraine (19/22 TMS, 8/12 tDCS). Quality of evidence ranged from very low to high. Conclusion Of all TMS and tDCS modalities, rTMS is most promising with moderate evidence that it contributes to reductions in headache frequency, duration, intensity, abortive medication use, depression, and functional impairment. However, only few studies reported changes greater than sham treatment. Further high‐quality RCTs with standardized protocols are required for each specific headache disorder to validate a treatment effect. Registration Number: PROSPERO 2017 CRD42017076232.

Alleviation of migraine symptoms by application of repetitive peripheral magnetic stimulation to myofascial trigger points of neck and shoulder muscles – A randomized trial

“…Moreover, the female predominance of this cohort has to be considered. However, females usually outnumber male patients in migraine trials, including studies of the other neuromodulatory approaches [61][62][63] . On the one hand, this fact corresponds to the overall higher prevalence of migraine in women in epidemiological studies 4,64,65 .…”

Effectiveness and Tolerability of Repetitive Transcranial Magnetic Stimulation for Preventive Treatment of Episodic Migraine: A Single Centre, Randomised, Double-Blind, Sham-Controlled Phase 2 Trial (Magnet-EM).

“…Many researchers had conducted rTMS trials to determine the e cacy of rTMS as treatment of both chronic and episodic migraine. In a recent systematic review (12), three studies were graded as high quality study with low risk of overall bias. In the rst study, the researchers did a parallel group, randomised, double-blind clinical trial on 11 chronic migraine patients (10).…”

“…TMS is widely considered to be a safe technique, however, has induced brief seizures in a small number of individuals worldwide (5,12,15). Since 1998, seizures due to TMS have occurred, but mostly in studies operating outside the safe limits previously de ned.…”

Optogenetics in Brain Research: From a Strategy to Investigate Physiological Function to a Therapeutic Tool

“…In the following section, we will introduce recent studies that exploited optogenetics as a treatment and rehabilitation strategy compared to other low-or non-invasive brain stimulation techniques (NIBS). Indeed, NIBS like transcranial Electrical Stimulation (tES) or Transcranial Magnetic Stimulation (TMS) demonstrated promising results in post-stroke recovery, anxiety, and depression treatment, in addition to improving Parkinson's symptoms in human patients [102][103][104][105][106][107][108][109]. Nevertheless, these methods are non-selective and limited by the low spatial resolution, which induces activity changes of all cell types near the stimulated site.…”