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Papers of the Week


Papers: 14 Sep 2019 - 20 Sep 2019


Human Studies

PAIN TYPE:
Migraine/Headache


2020 Jan 15


J Neurotrauma


37


2

Treatment of persistent post-traumatic headache and post-concussion symptoms using rTMS: a pilot, double-blind, randomized controlled trial.

Authors

Stilling JM, Paxman E, Mercier LJ, Gan L S, Wang M, Amoozegar F, Dukelow SP, Monchi O, Debert CT
J Neurotrauma. 2020 Jan 15; 37(2):312-323.
PMID: 31530227.

Abstract

Persistent post-traumatic headache (PTH) following mild traumatic brain injury (mTBI) is one of the most prominent and highly reported persistent post-concussion symptoms (PPCS). Non-pharmacologic treatments, including non-invasive neurostimulation technologies, have been proposed for use. Our objective was to evaluate headache characteristics at one-month following repetitive transcranial magnetic stimulation (rTMS) treatment in participants with PTH and PPCS. A double-blind, randomized, sham-controlled, pilot clinical trial was performed on twenty participants (18-65 years) with persistent PTH (ICHD-3) and PPCS (ICD-10). Ten sessions of rTMS therapy (10Hz, 600 pulses, 70% resting motor threshold amplitude) were delivered to the left dorsolateral prefrontal cortex (DLPFC). The primary outcome was a change in headache frequency or severity at one-month post-rTMS. Two-week long daily headache diaries and clinical questionnaires assessing function, PPCS, cognition, quality of life, and mood were completed at baseline, post-treatment, and at one-, three-, and six-months post-rTMS. A two-way (treatment x time) mixed ANOVA indicated a significant overall time effect for average headache severity [F(3,54)= 3.214, p=0.03] and a reduction in headache frequency at one-month post-treatment (#/two-weeks: REAL -5.2 (SD=5.8), SHAM -3.3 (SD=7.7). Secondary outcomes revealed an overall time interaction for headache impact, depression, post-concussion symptoms, and quality of life. There was a significant reduction in depression rating in the REAL group between baseline and one-month post-treatment, with no change in the SHAM group (PHQ-9; REAL -4.3 (SD=3.7, p=0.020), SHAM -0.7 (SD=4.7, p=1.0), Bonferroni corrected). In the REAL group, 60% returned to work while only 10% returned in the SHAM group (p=0.027). This pilot study demonstrates an overall time effect on headache severity, functional impact, depression, PPCS, and quality of life following rTMS treatment in participants with persistent PTH, however, findings were below clinical significance thresholds. There was a 100% response rate, no dropouts, and minimal adverse effects, warranting a larger phase II study.