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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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Fan L, Li Y, Zhao X, Huang ZG, Liu T, Wang J. Dynamic nonreversibility view of intrinsic brain organization and brain dynamic analysis of repetitive transcranial magnitude stimulation. Cereb Cortex 2024; 34:bhae098. [PMID: 38494890 DOI: 10.1093/cercor/bhae098] [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: 01/14/2024] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024] Open
Abstract
Intrinsic neural activities are characterized as endless spontaneous fluctuation over multiple time scales. However, how the intrinsic brain organization changes over time under local perturbation remains an open question. By means of statistical physics, we proposed an approach to capture whole-brain dynamics based on estimating time-varying nonreversibility and k-means clustering of dynamic varying nonreversibility patterns. We first used synthetic fMRI to investigate the effects of window parameters on the temporal variability of varying nonreversibility. Second, using real test-retest fMRI data, we examined the reproducibility, reliability, biological, and physiological correlation of the varying nonreversibility substates. Finally, using repetitive transcranial magnetic stimulation-fMRI data, we investigated the modulation effects of repetitive transcranial magnetic stimulation on varying nonreversibility substate dynamics. The results show that: (i) as window length increased, the varying nonreversibility variance decreased, while the sliding step almost did not alter it; (ii) the global high varying nonreversibility states and low varying nonreversibility states were reproducible across multiple datasets and different window lengths; and (iii) there were increased low varying nonreversibility states and decreased high varying nonreversibility states when the left frontal lobe was stimulated, but not the occipital lobe. Taken together, these results provide a thermodynamic equilibrium perspective of intrinsic brain organization and reorganization under local perturbation.
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Affiliation(s)
- Liming Fan
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Institute of Health and Rehabilitation Science, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
- National Engineering Research Center of Health Care and Medical Devices, Guangzhou, Guangdong 510500, China
| | - Youjun Li
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Institute of Health and Rehabilitation Science, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
- National Engineering Research Center of Health Care and Medical Devices, Guangzhou, Guangdong 510500, China
| | - Xingjian Zhao
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Institute of Health and Rehabilitation Science, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
- National Engineering Research Center of Health Care and Medical Devices, Guangzhou, Guangdong 510500, China
| | - Zi-Gang Huang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Institute of Health and Rehabilitation Science, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
- National Engineering Research Center of Health Care and Medical Devices, Guangzhou, Guangdong 510500, China
| | - Tian Liu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Institute of Health and Rehabilitation Science, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
- National Engineering Research Center of Health Care and Medical Devices, Guangzhou, Guangdong 510500, China
| | - Jue Wang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Institute of Health and Rehabilitation Science, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
- National Engineering Research Center of Health Care and Medical Devices, Guangzhou, Guangdong 510500, China
- The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi'an, Shaanxi 710049, China
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Viganò A, Sasso D’Elia T, Sava SL, Colosimo A, Di Piero V, Magis D, Schoenen J. Exploring the Therapeutic Potential of Quadripulse rTMS over the Visual Cortex: A Proof-of-Concept Study in Healthy Volunteers and Chronic Migraine Patients with Medication Overuse Headache. Biomedicines 2024; 12:288. [PMID: 38397890 PMCID: PMC10886990 DOI: 10.3390/biomedicines12020288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 02/25/2024] Open
Abstract
In chronic migraine with medication overuse (CM-MOH), sensitization of visual cortices is reflected by (i) increased amplitude of stimulus-evoked responses and (ii) habituation deficit during repetitive stimulation. Both abnormalities might be mitigated by inhibitory transcranial neurostimulation. Here, we tested an inhibitory quadripulse repetitive transcranial magnetic stimulation (rTMS-QPI) protocol to decrease durably visual cortex excitability in healthy subjects (HS) and explored its therapeutic potential in CM-MOH patients. Pattern-reversal visual evoked potentials (VEP) were used as biomarkers of effect and recorded before (T1), immediately after (T2), and 3 h after stimulation (T3). In HS, rTMS-QPI durably decreased the VEP 1st block amplitude (p < 0.05) and its habituation (p < 0.05). These changes were more pronounced for the P1N2 component that was modified already at T2 up to T3, while for N1P1 they were significant only at T3. An excitatory stimulation protocol (rTMS-QPE) tended to have an opposite effect, restricted to P1N2. In 12 CM-MOH patients, during a four-week treatment (2 sessions/week), rTMS-QPI significantly reduced monthly headache days (p < 0.01). In patients reversing from CM-MOH to episodic migraine (n = 6), VEP habituation significantly improved after treatment (p = 0.005). rTMS-QPI durably decreases visual cortex responsivity in healthy subjects. In a proof-of-concept study of CM-MOH patients, rTMS-QPI also has beneficial clinical and electrophysiological effects, but sham-controlled trials are needed.
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Affiliation(s)
- Alessandro Viganò
- Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium
| | - Tullia Sasso D’Elia
- Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium
- IRCCS San Raffaele Alla Pisana, 00163 Rome, Italy
| | - Simona Liliana Sava
- Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium
- Headache Clinic of Valdor—ISOSL, 4020 Liège, Belgium
| | - Alfredo Colosimo
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics Sapienza, Sapienza—University of Rome, 00185 Rome, Italy
| | - Vittorio Di Piero
- Subintensive Neurology & Headache Centre, Department of Human Neurosciences, Sapienza—University of Rome, 00185 Rome, Italy
| | - Delphine Magis
- Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium
- Neurology Department and Pain Clinic (CMTD), CHR East Belgium, 4800 Verviers, Belgium
| | - Jean Schoenen
- Headache Research Unit, Department of Neurology, University of Liège, Citadelle Hospital, 4000 Liège, Belgium
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Reffat N, Pusec C, Price S, Gupta M, Mavrocordatos P, Abd-Elsayed A. Neuromodulation Techniques for Headache Management. Life (Basel) 2024; 14:173. [PMID: 38398683 PMCID: PMC10890676 DOI: 10.3390/life14020173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
This narrative review aims to summarize evidence regarding the current utilization and future applications of neuromodulation in patients with headaches, with special attention paid to migraine and chronic cluster headache. A search was conducted in PubMed in August of 2023 to survey the current literature on neuromodulation for the treatment of headache. In total, the search yielded 1989 results, which were further filtered to include only systematic reviews published between 2022 to 2023 to capture the most up-to-date and comprehensive research on this topic. The citation lists of these articles were reviewed to find additional research on neuromodulation and supplement the results presented in this paper with primary literature. Research on the use of neuromodulation for the treatment of headache has predominantly focused on four neuromodulation techniques: peripheral nerve stimulation (PNS), transcranial magnetic stimulation (TMS), deep brain stimulation (DBS), and spinal cord stimulation (SCS). Outcome measures reported in this article include impact on migraine and headache frequency and/or pain intensity, adverse effects of the neuromodulation technique, and associated costs, when available. We found that neuromodulation has developed utility as an alternative treatment for both chronic cluster headaches and migraines, with a reduction in frequency and intensity of headache most elucidated from the articles mentioned in this review.
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Affiliation(s)
- Noora Reffat
- School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA; (N.R.)
| | - Carolina Pusec
- Department of Neurology, University of Wisconsin Health, Madison, WI 53705, USA
| | - Scott Price
- School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA; (N.R.)
| | - Mayank Gupta
- Kansas Pain Management & Neuroscience Research Center, Kansas City, KS 66214, USA
| | | | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin Health, Madison, WI 53705, USA
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Abstract
PURPOSE OF REVIEW Chronic migraine (CM) affects a large proportion of the population and is a significant source of disability and lost productivity. Numerous non-pharmacological approaches have been attempted during the past decades. This review discusses the most recent and evidence-based advances in acute and preventive non-pharmacological therapeutic approaches for CM, offering alternatives to drug treatment. RECENT FINDINGS A growing number of non-pharmacological treatment options, including non-invasive or invasive neuromodulation, acupuncture, psychotherapy, and physiotherapy, have shown promising efficacy in CM. There is strong evidence for the effectiveness of non-invasive neuromodulation such as transcranial magnetic stimulation, transcranial direct current stimulation, and transcutaneous electrical nerve stimulation (TENS) in CM, but less evidence for approaches such as invasive neuromodulation, physical therapy, or dietary approaches. Acupuncture for migraine remains controversial, with the main point of contention still being the placebo effect. Non-pharmacological approaches can be offered as a reliable alternative for patients with CM, and more research is being done to evaluate the efficacy of non-invasive neuromodulation with different parameters and the combination of different treatments in CM.
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Affiliation(s)
- Xun Han
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Shengyuan Yu
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Shen M, Li C, Wei X, Zhang L, Li Y, Wu H, Zhang X, Dong Z, Gao S, Ma Y, Ma Y. Transcranial Magnetic Stimulation as a Therapy for Migraine: An Overview of Systematic Reviews. J Pain Res 2023; 16:3133-3144. [PMID: 37724171 PMCID: PMC10505396 DOI: 10.2147/jpr.s416993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023] Open
Abstract
Introduction This overview of systematic reviews (SRs) systematically collected, evaluated, and combined the evidence for migraine treatment with transcranial magnetic stimulation (TMS). Methods We conducted a systematic literature search in various databases, such as PubMed, The Cochrane Library, Web of Science, Embase, the China National Knowledge Infrastructure, Wanfang, VIP, and China Biomedical Literature. Two reviewers independently assessed the methodological quality, risk of bias, reporting quality, and strength of evidence of the included studies using AMSTAR-2, ROBIS, the PRISMA checklist, and the GRADE system. Results We performed an overview of 7 relevant SRs, of which 4 were of moderate quality and 3 were of low quality according to AMSTAR 2. All SRs had low risk of bias in Phase 1 (Assessing relevance), Domain 1 (Study eligibility criteria), and Domain 4 (Synthesis and findings) as evaluated by ROBIS. In Domain 2 (Identification and selection of studies), 4 SRs (57.1%) had low risk of bias, while in Domain 3 (data collection and study appraisal) and Risk of Bias in the Review Phase 3, 4 SRs (57.1%) had low risk of bias. The PRISMA reporting standards were generally comprehensive, but some limitations were observed in the assessments, pooled results, evidence reliability, registration and protocols, and funding sources. The GRADE levels ranged from moderate to low, with 10 outcomes of moderate quality and 6 outcomes of low quality. The main reason for the low quality of evidence was the small sample size and high heterogeneity of the available studies. Conclusion TMS may improve migraine severity and frequency, but the evidence is limited due to methodological flaws and heterogeneity. Future studies should standardize use, assess side effects, and compare with other treatments.
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Affiliation(s)
- Min Shen
- Department of Acupuncture and Massage College, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
| | - Chunjing Li
- Department of Acupuncture and Massage College, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
| | - Xiaocen Wei
- Department of Acupuncture and Massage College, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
| | - Linlin Zhang
- Department of Acupuncture and Massage College, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
| | - Yang Li
- Department of Acupuncture and Massage College, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
| | - Hongxue Wu
- Department of Rehabilitation, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Xiaobin Zhang
- Department of Acupuncture and Massage College, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
| | - Zhibin Dong
- Department of Acupuncture and Massage College, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
| | - Shuzhong Gao
- Department of Acupuncture and Massage College, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
| | - Yuning Ma
- Department of Acupuncture and Massage College, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
| | - Yuxia Ma
- Department of Acupuncture and Massage College, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
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Chen SP. Migraine and treatment-resistant depression. PROGRESS IN BRAIN RESEARCH 2023; 281:149-173. [PMID: 37806714 DOI: 10.1016/bs.pbr.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Migraine and major depressive disorders (MDD) or treatment resistant depression (TRD) represent a significant global burden and are often comorbid, further complicating diagnosis and treatment. Epidemiological studies have demonstrated a bidirectional relationship between migraine and MDD/TRD, with patients suffering from one disorder exhibiting a heightened risk of developing the other. This association is believed to result from shared genetic factors, neurotransmitter dysregulation, inflammation, hormonal alteration, and other conditions comorbid with both disorders. Emerging evidence suggests that therapeutics targeting common pathways in both disorders may be beneficial for comorbid patients. Novel therapeutics for migraine or MDD/TRD, such as calcitonin gene-related peptide (CGRP)-targeting therapy, onabotulinumtoxinA, ketamine/esketamine, vagus nerve stimulation or transcranial magnetic stimulation, may be helpful in selected patients with comorbid migraine-MDD/TRD. Nevertheless, continued efforts are needed to improve early detection and intervention, to better understand the complex interplay between genetic, environmental, and psychosocial factors contributing to this comorbidity, to identify novel therapeutic targets, and ultimately, to alleviate the disease burden caused by this comorbidity.
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Affiliation(s)
- Shih-Pin Chen
- Department of Medical Research & Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan; Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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