Q: Have you heard about the use of magnetic stimulation to treat headaches?
A: Transcranial magnetic stimulation (TMS) is a technique that applies a brief magnetic pulse to the scalp and underlying brain. It was evaluated for the treatment of migraine based on the theory that a fluctuating magnetic field applied to the scalp would induce an electrical current. This would then disrupt the spread of abnormal brain currents, called cortical spreading depression (CSD), that are involved in migraine. Animal studies suggest that CSD can trigger pain receptors in the membranes that envelop the brain.
A small, randomized, double-blind, sham-controlled trial evaluated the use of single-pulse TMS in 164 patients who had migraine with aura. The study found that more patients who received treatment with TMS were pain-free at two hours than those who received the sham treatment (39% vs. 22%). The trial was not able to show a reduction in pain from moderate/severe to mild/no headache.
TMS may be a promising and exciting new noninvasive, acute treatment option for patients who have migraine with aura, but more research is still needed to evaluate safety concerns, as it is theoretically possible that TMS could trigger seizures.
Barbara Lee Peterlin, MD, Drexel University of Medicine, Philadelphia
