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

IF 3.2 2区医学 Q2 CLINICAL NEUROLOGY Current Pain and Headache Reports Pub Date : 2024-04-01 Epub Date: 2024-01-26 DOI:10.1007/s11916-024-01210-0

Emily Stephens, Chathurika S Dhanasekara, Victor Montalvan, Bei Zhang, Ashley Bassett, Rebecca Hall, Alyssa Rodaniche, Christina Robohm-Leavitt, Chwan-Li Shen, Chanaka N Kahatuduwa

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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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重复经颅磁刺激对慢性日常头痛预防的效用：系统回顾与元分析》。

综述目的：由于标准预防性药物治疗的疗效有限，慢性日常头痛（CDH）的治疗仍具有挑战性。一些研究报告称，重复经颅磁刺激（rTMS）可有效治疗慢性头痛。该研究旨在确定经颅磁刺激在治疗后立即和持续预防 CDH 方面的效用：所有程序均按照 PRISMA 指南进行。我们在 PubMed、Scopus、Web of Science 和 ProQuest 数据库中搜索了测试经颅磁刺激对 CDH 患者疗效的对照临床试验。使用 R 中的 "meta "软件包进行了 DerSimonian-Laird 随机效应荟萃分析，以检验经颅磁刺激后与经颅磁刺激前相比，假对照条件下标准化头痛强度和频率的变化。共纳入了 13 项试验，研究对象包括 N = 538 名 CDH 患者（经颅磁刺激，N = 284；假对照，N = 254）。接受经颅磁刺激治疗的患者在治疗后的一段时间内，CDH的标准化强度和频率明显降低（Hedges' g = -1.16 [-1.89, -0.43]，p = 0.002；Δ = -5.07 [-10.05, -0.11]，p = 0.045）。然而，这些影响在随访期间略有持续（Hedges' g = -0.43 [-0.76, -0.09], p = 0.012 和 Δ = -3.33 [-5.52, -1.14], p = 0.003）。研究之间存在显著的异质性，至少部分原因是经颅磁刺激方案的不同。尽管在治疗后短期内观察到了具有临床意义和统计学意义的疗效，但经颅磁刺激对 CDH 的预防效果似乎并不会随着治疗的中断而持续。因此，常规使用经颅磁刺激对 CDH 进行预防的成本效益仍然值得怀疑：协议已在 PROSPERO 国际系统综述前瞻性注册中心（CRD42021250100）注册。

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来源期刊

Current Pain and Headache Reports CLINICAL NEUROLOGY-

CiteScore

6.10

自引率

2.70%

发文量

审稿时长

6-12 weeks

期刊介绍： This journal aims to review the most important, recently published clinical findings regarding the diagnosis, treatment, and management of pain and headache. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care and prevention of pain and headache. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as anesthetic techniques in pain management, cluster headache, neuropathic pain, and migraine. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.