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Magnetic stimulation shows promise for migraine with aura

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – A portable magnetic stimulation device is a promising noninvasive, drug-free treatment for acute migraine with aura, according to a March 4th online report in The Lancet Neurology.

However, although the single-pulse transcranial magnetic stimulation (TMS) was more effective than sham treatment, most patients still had some pain, the report indicates.

Transcranial magnetic stimulation has been “tested in individuals with migraine based on the hypothesis that a fluctuating magnetic field…applied to the back of the head, would induce electrical current and disrupt cortical spreading depression,” lead author Dr. Richard B. Lipton, from Albert Einstein College of Medicine, Bronx, New York, and co-researchers explain.

In the current study, Dr. Lipton’s team assessed response rates in 201 patients with migraine with aura who took home the hand-held Cerena Transcranial Magnetic Stimulator for TMS, or an identical sham device.

Over the 3-month study period, patients treated up to three migraine attacks while experiencing aura. Thirty-seven participants did not treat a migraine attack and were excluded from further analysis.

The main outcome — no pain 2 hours after the first attack – occurred in 39% of TMS patients and 22% of sham treatment patients (p = 0.0179). Rates of sustained pain-free response at 24 hours were 29% vs. 16% and at 48 hours, 27% vs. 13% (p < 0.05 for both).

Non-inferiority analysis indicated that TMS was at least as effective as sham treatment in combating nausea, photophobia, and phonophobia.

No serious device-related events occurred, and the rate and severity of events was comparable in each patient group.

“For patients who commonly have aura as a signal of an impending migraine, treatment with single-pulse TMS may abort progression of the attack and abate disabling pain and other symptoms,” the authors conclude.

Because there is evidence of cortical spreading depression in migraine without aura, it is possible that TMS may be an effective treatment for these headaches as well, they add.

In an editorial, Dr. Hans-Christoph Diener of University Hospital Essen in Germany writes that with more research, “the use of TMS could be a major step forward in the treatment of migraine with aura, particularly in patients in whom presently available drug treatment is ineffective, poorly tolerated, or contraindicated.”

Reference:

Lancet Neurol 2010.