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Utility of Repetitive Transcranial Magnetic Stimulation for Chronic Daily Headache Prophylaxis: A Systematic Review and Meta-Analysis

  • Chronic Daily Headache (S-J Wang and S-P Chen, Section Editors)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

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.

Summary

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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Data Availability

The datasets generated during and analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

CDH :

Chronic daily headaches

CM:

Chronic migraine

CTTH:

Chronic tension-type headaches

TCA:

Tricyclic antidepressants

BTX-A:

Botulinum toxin A

CGRP :

Calcitonin gene-related peptide

rTMS :

Repetitive transcranial magnetic stimulation

dlPFC :

Dorsolateral prefrontal cortex

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analyses

MCID:

Minimal clinically important difference

GRADE:

Grading of Recommendations, Assessment, Development, and Evaluation

MC:

Motor cortex

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Funding

The study was funded in part by the Medical Student Summer Research Project of the School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, 2021.

Author information

Author notes

  1. Ashley Bassett, Rebecca Hall and Alyssa Rodaniche authors contributed equally to this work.

Authors and Affiliations

  1. School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Emily Stephens

  2. Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Chathurika S. Dhanasekara

  3. Department of Neurology, School of Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX, 79430, USA

    Victor Montalvan & Chanaka N. Kahatuduwa

  4. Department of Neurology, Division of Vascular Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Victor Montalvan

  5. Division of Physical Medicine and Rehabilitation, Department of Neurology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Bei Zhang

  6. Department of Laboratory Science and Primary Care, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Ashley Bassett, Rebecca Hall, Alyssa Rodaniche & Christina Robohm-Leavitt

  7. Department of Pathology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Chwan-Li Shen

  8. Center of Excellence for Integrative Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Chwan-Li Shen & Chanaka N. Kahatuduwa

  9. Center of Excellence for Translational Neuroscience and Therapeutics, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Chwan-Li Shen & Chanaka N. Kahatuduwa

  10. Department of Psychiatry, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Chanaka N. Kahatuduwa

Authors
  1. Emily Stephens
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  3. Victor Montalvan
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  5. Ashley Bassett
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  6. Rebecca Hall
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  7. Alyssa Rodaniche
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  8. Christina Robohm-Leavitt
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  9. Chwan-Li Shen
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  10. Chanaka N. Kahatuduwa
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Contributions

CSD and CNK have full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. CSD, CLS, CRL, and CNK designed the study; ES, AB, RH, AR and CSD collected the data; CLS, CRL and CNK supervised data collection; CSD and CNK extracted and analyzed the data; ES, CSD and CNK wrote the manuscript; all authors read, revised and helped finalize the manuscript. All authors accept full responsibility for all aspects of to the work described.

Corresponding author

Correspondence to Chanaka N. Kahatuduwa.

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Stephens, E., Dhanasekara, C.S., Montalvan, V. et al. Utility of Repetitive Transcranial Magnetic Stimulation for Chronic Daily Headache Prophylaxis: A Systematic Review and Meta-Analysis. Curr Pain Headache Rep 28, 149–167 (2024). https://doi.org/10.1007/s11916-024-01210-0

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