The effect of prophylactic medications on TMS for migraine aura

Amy C. Almaraz, Esma Dilli, David William Dodick

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Purpose.- Low frequency transcranial magnetic stimulation (TMS) has recently been shown to be effective for the acute treatment of migraine with aura. TMS has recently been shown to inhibit cortical spreading depression (CSD). Prophylactic medications (PM) may reduce the frequency of migraine attacks by elevating CSD threshold. The interaction between PM and TMS is unknown. Methods.- Subgroup analysis was performed on a double-blind, Sham-controlled study that evaluated the efficacy and safety of TMS for the acute treatment of migraine with aura. Analysis of the primary efficacy endpoint pain-free at 2 hours (pain-free rate [PFR]) between TMS and Sham groups was performed based on the non-randomized use of PM. Results.- A total of 164 subjects eligibly treated at least 1 migraine with aura attack with TMS (n = 82) or Sham stimulation (n = 82). Baseline pain intensity at the time of treatment for the first attack was no pain (31%), mild (40%), moderate (23%), or severe pain (6%). PM were used by 37% (31/82) and 41.5% (34/82) in the Sham- and TMS-treated patients, respectively. Sham patients on no PM (Sham without) had significantly higher PFR than Sham-treated patients on PM (Sham with) (P = .0014). There was no difference in PFR between TMS-treated patients on (TMS with) or off (TMS without) PM (P = .5513). However, TMS with had significantly higher PFR than Sham with patients (P = .002). There was no difference in PFR between TMS without and Sham without patients (P = .4061). Conclusion.- Prophylactic medications do not appear to influence the treatment response to TMS. The better response in Sham-treated patients not on PM may indicate a more responsive subgroup or different patient phenotype than those currently using PM. These findings will need to be verified in a larger patient sample randomized by presence or absence of PM.

Original languageEnglish (US)
Pages (from-to)1630-1633
Number of pages4
JournalHeadache
Volume50
Issue number10
DOIs
StatePublished - Nov 2010

Fingerprint

Transcranial Magnetic Stimulation
Migraine Disorders
Epilepsy
Migraine with Aura
Cortical Spreading Depression
Pain
Therapeutics
Pain-Free

Keywords

  • aura
  • migraine
  • transcranial magnetic stimulation

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

The effect of prophylactic medications on TMS for migraine aura. / Almaraz, Amy C.; Dilli, Esma; Dodick, David William.

In: Headache, Vol. 50, No. 10, 11.2010, p. 1630-1633.

Research output: Contribution to journalArticle

Almaraz, Amy C. ; Dilli, Esma ; Dodick, David William. / The effect of prophylactic medications on TMS for migraine aura. In: Headache. 2010 ; Vol. 50, No. 10. pp. 1630-1633.
@article{f3029685fd7d43e2a43bc6822ce2d00d,
title = "The effect of prophylactic medications on TMS for migraine aura",
abstract = "Purpose.- Low frequency transcranial magnetic stimulation (TMS) has recently been shown to be effective for the acute treatment of migraine with aura. TMS has recently been shown to inhibit cortical spreading depression (CSD). Prophylactic medications (PM) may reduce the frequency of migraine attacks by elevating CSD threshold. The interaction between PM and TMS is unknown. Methods.- Subgroup analysis was performed on a double-blind, Sham-controlled study that evaluated the efficacy and safety of TMS for the acute treatment of migraine with aura. Analysis of the primary efficacy endpoint pain-free at 2 hours (pain-free rate [PFR]) between TMS and Sham groups was performed based on the non-randomized use of PM. Results.- A total of 164 subjects eligibly treated at least 1 migraine with aura attack with TMS (n = 82) or Sham stimulation (n = 82). Baseline pain intensity at the time of treatment for the first attack was no pain (31{\%}), mild (40{\%}), moderate (23{\%}), or severe pain (6{\%}). PM were used by 37{\%} (31/82) and 41.5{\%} (34/82) in the Sham- and TMS-treated patients, respectively. Sham patients on no PM (Sham without) had significantly higher PFR than Sham-treated patients on PM (Sham with) (P = .0014). There was no difference in PFR between TMS-treated patients on (TMS with) or off (TMS without) PM (P = .5513). However, TMS with had significantly higher PFR than Sham with patients (P = .002). There was no difference in PFR between TMS without and Sham without patients (P = .4061). Conclusion.- Prophylactic medications do not appear to influence the treatment response to TMS. The better response in Sham-treated patients not on PM may indicate a more responsive subgroup or different patient phenotype than those currently using PM. These findings will need to be verified in a larger patient sample randomized by presence or absence of PM.",
keywords = "aura, migraine, transcranial magnetic stimulation",
author = "Almaraz, {Amy C.} and Esma Dilli and Dodick, {David William}",
year = "2010",
month = "11",
doi = "10.1111/j.1526-4610.2010.01787.x",
language = "English (US)",
volume = "50",
pages = "1630--1633",
journal = "Headache",
issn = "0017-8748",
publisher = "Wiley-Blackwell",
number = "10",

}

TY - JOUR

T1 - The effect of prophylactic medications on TMS for migraine aura

AU - Almaraz, Amy C.

AU - Dilli, Esma

AU - Dodick, David William

PY - 2010/11

Y1 - 2010/11

N2 - Purpose.- Low frequency transcranial magnetic stimulation (TMS) has recently been shown to be effective for the acute treatment of migraine with aura. TMS has recently been shown to inhibit cortical spreading depression (CSD). Prophylactic medications (PM) may reduce the frequency of migraine attacks by elevating CSD threshold. The interaction between PM and TMS is unknown. Methods.- Subgroup analysis was performed on a double-blind, Sham-controlled study that evaluated the efficacy and safety of TMS for the acute treatment of migraine with aura. Analysis of the primary efficacy endpoint pain-free at 2 hours (pain-free rate [PFR]) between TMS and Sham groups was performed based on the non-randomized use of PM. Results.- A total of 164 subjects eligibly treated at least 1 migraine with aura attack with TMS (n = 82) or Sham stimulation (n = 82). Baseline pain intensity at the time of treatment for the first attack was no pain (31%), mild (40%), moderate (23%), or severe pain (6%). PM were used by 37% (31/82) and 41.5% (34/82) in the Sham- and TMS-treated patients, respectively. Sham patients on no PM (Sham without) had significantly higher PFR than Sham-treated patients on PM (Sham with) (P = .0014). There was no difference in PFR between TMS-treated patients on (TMS with) or off (TMS without) PM (P = .5513). However, TMS with had significantly higher PFR than Sham with patients (P = .002). There was no difference in PFR between TMS without and Sham without patients (P = .4061). Conclusion.- Prophylactic medications do not appear to influence the treatment response to TMS. The better response in Sham-treated patients not on PM may indicate a more responsive subgroup or different patient phenotype than those currently using PM. These findings will need to be verified in a larger patient sample randomized by presence or absence of PM.

AB - Purpose.- Low frequency transcranial magnetic stimulation (TMS) has recently been shown to be effective for the acute treatment of migraine with aura. TMS has recently been shown to inhibit cortical spreading depression (CSD). Prophylactic medications (PM) may reduce the frequency of migraine attacks by elevating CSD threshold. The interaction between PM and TMS is unknown. Methods.- Subgroup analysis was performed on a double-blind, Sham-controlled study that evaluated the efficacy and safety of TMS for the acute treatment of migraine with aura. Analysis of the primary efficacy endpoint pain-free at 2 hours (pain-free rate [PFR]) between TMS and Sham groups was performed based on the non-randomized use of PM. Results.- A total of 164 subjects eligibly treated at least 1 migraine with aura attack with TMS (n = 82) or Sham stimulation (n = 82). Baseline pain intensity at the time of treatment for the first attack was no pain (31%), mild (40%), moderate (23%), or severe pain (6%). PM were used by 37% (31/82) and 41.5% (34/82) in the Sham- and TMS-treated patients, respectively. Sham patients on no PM (Sham without) had significantly higher PFR than Sham-treated patients on PM (Sham with) (P = .0014). There was no difference in PFR between TMS-treated patients on (TMS with) or off (TMS without) PM (P = .5513). However, TMS with had significantly higher PFR than Sham with patients (P = .002). There was no difference in PFR between TMS without and Sham without patients (P = .4061). Conclusion.- Prophylactic medications do not appear to influence the treatment response to TMS. The better response in Sham-treated patients not on PM may indicate a more responsive subgroup or different patient phenotype than those currently using PM. These findings will need to be verified in a larger patient sample randomized by presence or absence of PM.

KW - aura

KW - migraine

KW - transcranial magnetic stimulation

UR - http://www.scopus.com/inward/record.url?scp=78649250681&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78649250681&partnerID=8YFLogxK

U2 - 10.1111/j.1526-4610.2010.01787.x

DO - 10.1111/j.1526-4610.2010.01787.x

M3 - Article

C2 - 21198566

AN - SCOPUS:78649250681

VL - 50

SP - 1630

EP - 1633

JO - Headache

JF - Headache

SN - 0017-8748

IS - 10

ER -