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Stephens E, Dhanasekara CS, Montalvan V, Zhang B, Bassett A, Hall R, Rodaniche A, Robohm-Leavitt C, Shen CL, Kahatuduwa CN. Utility of Repetitive Transcranial Magnetic Stimulation for Chronic Daily Headache Prophylaxis: A Systematic Review and Meta-Analysis. Curr Pain Headache Rep 2024; 28:149-167. [PMID: 38277066 DOI: 10.1007/s11916-024-01210-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE OF REVIEW Management of chronic daily headaches (CDH) remains challenging due to the limited efficacy of standard prophylactic pharmacological measures. Several studies have reported that repetitive transcranial magnetic stimulation (rTMS) can effectively treat chronic headaches. The objective was to determine the utility of rTMS for immediate post-treatment and sustained CDH prophylaxis. RECENT FINDINGS All procedures were conducted per PRISMA guidelines. PubMed, Scopus, Web of Science, and ProQuest databases were searched for controlled clinical trials that have tested the efficacy of rTMS on populations with CDH. DerSimonian-Laird random-effects meta-analyses were performed using the 'meta' package in R to examine the post- vs. pre-rTMS changes in standardized headache intensity and frequency compared to sham-control conditions. Thirteen trials were included with a combined study population of N = 538 patients with CDH (rTMS, N = 284; Sham, N = 254). Patients exposed to rTMS had significantly reduced standardized CDH intensity and frequency in the immediate post-treatment period (Hedges' g = -1.16 [-1.89, -0.43], p = 0.002 and Δ = -5.07 [-10.05, -0.11], p = 0.045 respectively). However, these effects were sustained marginally in the follow-up period (Hedges' g = -0.43 [-0.76, -0.09], p = 0.012 and Δ = -3.33 [-5.52, -1.14], p = 0.003). Significant between-study heterogeneity was observed, at least partially driven by variations in rTMS protocols. Despite the observed clinically meaningful and statistically significant benefits in the immediate post-treatment period, the prophylactic effects of rTMS on CDH do not seem to sustain with discontinuation. Thus, the cost-effectiveness of the routine use of rTMS for CDH prophylaxis remains questionable. REGISTRATION Protocol preregistered in PROSPERO International Prospective Register of Systematic Reviews (CRD42021250100).
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Affiliation(s)
- Emily Stephens
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Chathurika S Dhanasekara
- Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Victor Montalvan
- Department of Neurology, School of Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX, 79430, USA
- Department of Neurology, Division of Vascular Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bei Zhang
- Division of Physical Medicine and Rehabilitation, Department of Neurology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Ashley Bassett
- Department of Laboratory Science and Primary Care, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Rebecca Hall
- Department of Laboratory Science and Primary Care, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Alyssa Rodaniche
- Department of Laboratory Science and Primary Care, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Christina Robohm-Leavitt
- Department of Laboratory Science and Primary Care, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Chwan-Li Shen
- Department of Pathology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Center of Excellence for Integrative Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Center of Excellence for Translational Neuroscience and Therapeutics, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Chanaka N Kahatuduwa
- Department of Neurology, School of Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX, 79430, USA.
- Center of Excellence for Integrative Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
- Center of Excellence for Translational Neuroscience and Therapeutics, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
- Department of Psychiatry, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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Song X, Yu SB, Yuan XY, Alam Shah MA, Li C, Chi YY, Zheng N, Sui HJ. Evidence for chronic headaches induced by pathological changes of myodural bridge complex. Sci Rep 2024; 14:5285. [PMID: 38438423 PMCID: PMC10912660 DOI: 10.1038/s41598-024-55069-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
Clinical studies have shown that there may be a certain relationship between pathological changes of the myodural bridge complex (MDBC) and chronic headaches of unknown cause. But there is still a lack of experimental evidence to explain the possible mechanism. This study aims to further confirm this relationship between MDBC and chronic headaches and explore its potential occurrence mechanism in rats. Bleomycin (BLM) or phosphate-buffered saline (PBS) was injected into the myodural bridge fibers of rats to establish the hyperplastic model of MDBC. After 4 weeks, the occurrence of headaches in rats was evaluated through behavioral scores. The immunohistochemistry staining method was applied to observe the expression levels of headache-related neurotransmitters in the brain. Masson trichrome staining results showed that the number of collagen fibers of MDBC was increased in the BLM group compared to those of the other two groups. It revealed hyperplastic changes of MDBC. The behavioral scores of the BLM group were significantly higher than those of the PBS group and the blank control group. Meanwhile, expression levels of CGRP and 5-HT in the headache-related nuclei of the brain were increased in the BLM group. The current study further confirms the view that there is a relationship between pathological changes of MDBC and chronic headaches of unknown cause. This study may provide anatomical and physiological explanations for the pathogenesis of some chronic headaches of unknown cause.
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Affiliation(s)
- Xue Song
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China
| | - Sheng-Bo Yu
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China
| | - Xiao-Ying Yuan
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China
| | - M Adeel Alam Shah
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China
| | - Chan Li
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China
| | - Yan-Yan Chi
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China
| | - Nan Zheng
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China.
| | - Hong-Jin Sui
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, China.
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Singh RK, Kaushik RM, Goel D, Kaushik R. Association between iron deficiency anemia and chronic daily headache: A case-control study. Cephalalgia 2023; 43:3331024221143540. [PMID: 36739514 DOI: 10.1177/03331024221143540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We aimed to determine the association between iron deficiency anemia and chronic daily headache. METHODS This case-control study was conducted in a tertiary care center in Dehradun, India. One hundred patients with chronic daily headache were randomly selected for the study with an equal number of controls. Subsets of chronic daily headache were diagnosed as per the 3rd edition of the International Classification of Headache Disorders. The study participants were assessed for iron deficiency anemia. RESULTS The mean age of the patients was 51.1 ± 22.1 years. Male: female ratio was 1:1.08. Chronic migraine was present in 62 (62%), tension-type headache in 23 (23%), and new daily persistent headache in 15 (15%) patients. The majority (96%) of patients had chronic daily headache of mild to moderate severity. Chronic daily headache was of long duration in all patients. Sixty-four (64%) patients had anemia of which 51 (51%) patients had iron deficiency anemia. Iron deficiency anemia showed a significant association with chronic daily headache (p < 0.001), but not with its type, subtype, and duration. Severe iron deficiency anemia had a significant association with the severity of chronic daily headache (p = 0.021). Serum iron, ferritin, total iron-binding capacity, and transferrin saturation also had a significant association with chronic daily headache (p < 0.05 for each), but not with its type, subtype, duration, and severity. Logistic regression analysis showed that iron deficiency anemia, total iron-binding capacity, and transferrin saturation had an independent association with chronic daily headache (p < 0.05 for each). CONCLUSIONS Iron deficiency anemia had an independent association with chronic daily headache. Severe iron deficiency anemia was related to the severity of chronic daily headache.
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Affiliation(s)
- Rohit Kumar Singh
- Department of General Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Rajeev Mohan Kaushik
- Department of General Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Deepak Goel
- Department of Neurology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Reshma Kaushik
- Department of General Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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Laube JG, Salles Araujo T, Taw LB. Integrative East-West Medicine Intervention for Chronic Daily Headache: A Case Report and Care Perspective. Glob Adv Health Med 2020; 9:2164956120905817. [PMID: 32110474 PMCID: PMC7019391 DOI: 10.1177/2164956120905817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/20/2020] [Indexed: 11/15/2022] Open
Abstract
Chronic daily headache is a group of headache syndromes including most commonly chronic migraine and chronic tension-type headache, which often overlap, are complicated by medication overuse and are disabling, costly, and variable responsive to western pharmacotherapeutic interventions. There is growing research and awareness of integrative health approaches and therapies to address patients with chronic headache, yet limited examples of how to deliver this approach. This article reviews a commonly seen challenging case of a patient with overlapping chronic migraine and chronic tension-type headache complicated by medication overuse managed with an integrative east-west medicine intervention. This included person-centered biopsychosocial history taking, traditional Chinese medicine informed acupuncture, trigger point injections, and contributing factors modifications. A narrative review of the literature is presented to demonstrate an evidence-informed rationale for incorporating nonpharmacologic approaches to effectively help reduce the symptom burden of this patient population.
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Affiliation(s)
- Justin G Laube
- UCLA Center for East-West Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.,Division of General Internal Medicine and Health Service Research, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Thais Salles Araujo
- UCLA Center for East-West Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Lawrence B Taw
- UCLA Center for East-West Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.,Division of General Internal Medicine and Health Service Research, Department of Medicine, University of California, Los Angeles, Los Angeles, California
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A Systematic Review of the Soft-Tissue Connections Between Neck Muscles and Dura Mater: The Myodural Bridge. Spine (Phila Pa 1976) 2017; 42:49-54. [PMID: 27116115 DOI: 10.1097/brs.0000000000001655] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To elucidate the existence of soft tissue connections between the neck muscles and cervical dura mater. SUMMARY OF BACKGROUND DATA Several studies discuss the existence of a cervical myodural bridge; however, conflicting data have been reported. METHODS Searches were conducted in the PubMed, Web of Science, Cochrane Library, and PEDro databases. Studies reporting original data regarding the continuity of non-post-surgical soft tissue between the cervical muscles and dura mater were reviewed. Two reviewers independently selected articles, and a third one resolved disagreements. Another two researchers extracted the methodology of the study, the anatomical findings, and evaluated the quality of the studies using Quality Appraisal for Cadaveric Studies Scale. A different third researcher resolved disagreements. RESULTS Twenty-six studies were included. A soft tissue connection between the rectus capitis posterior minor, the rectus capitis posterior major, and the obliquus capitis inferior muscles seems to be proved with a strong level of evidence for each one of them. Controversy exists about the possible communication between the dura mater and the upper trapezius, rhomboideus minor, serratus posterior superior, and splenius capitis by means of the ligamentum nuchae. Finally, there is limited evidence about the existence of a soft tissue connection between rectus capitis anterior muscle and the dura mater. CONCLUSION There is a continuity of soft tissue between the cervical musculature and the cervical dura mater; this might have physiological, pathophysiological, and therapeutic implications, and going some way to explaining the effect of some therapies in craniocervical disorders. LEVEL OF EVIDENCE N/A.
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Yuan XY, Yu SB, Liu C, Xu Q, Zheng N, Zhang JF, Chi YY, Wang XG, Lin XT, Sui HJ. Correlation between chronic headaches and the rectus capitis posterior minor muscle: A comparative analysis of cross-sectional trail. Cephalalgia 2016; 37:1051-1056. [PMID: 27534669 DOI: 10.1177/0333102416664775] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective We aimed to investigate the morphological changes and potential correlation between chronic headaches and the rectus capitis posterior minor muscle (RCPmi). Methods Comparison of RCPmi between patients with chronic headaches and healthy adult volunteers were collected using magnetic resonance imaging (MRI) and Mimics software. Results Among the 235 MRI images analyzed, the data between the two groups were considered statistically significant. The number of males was larger than that of females ( p < 0.001) and the headache group showed greater hypertrophy than the control group in both males ( p < 0.001) and females ( p = 0.001). Conclusions Chronic headaches were correlated with the RCPmi. Patients with chronic headaches suffered from more obvious hypertrophy than that of the control group. Additionally, it was supposed that RCPmi hypertrophy may be one pathogenesis of the chronic headaches.
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Affiliation(s)
- Xiao-Ying Yuan
- 1 Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P. R. China
| | - Sheng-Bo Yu
- 1 Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P. R. China
| | - Cong Liu
- 1 Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P. R. China.,2 Department of Radiology, The 403 Affiliated Hospital of Chinese PLA General Hospital, Dalian, P. R. China
| | - Qiang Xu
- 2 Department of Radiology, The 403 Affiliated Hospital of Chinese PLA General Hospital, Dalian, P. R. China
| | - Nan Zheng
- 1 Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P. R. China
| | - Jian-Fei Zhang
- 1 Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P. R. China
| | - Yan-Yan Chi
- 1 Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P. R. China
| | - Xu-Gang Wang
- 3 Department of Neurology, The Second Affiliated Hospital of Dalian Medical University, Dalian, P. R. China
| | - Xiang-Tao Lin
- 4 Shangdong Medical Imaging Research Institute, School of Medicine, Shandong University, Jinan, P. R. China
| | - Hong-Jin Sui
- 1 Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P. R. China
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