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Transcranial Magnetic Stimulation for Migraine: A Safety Review

Authors

  • David W. Dodick MD,

    1. From Mayo Clinic, Phoenix, AZ, USA (D.W. Dodick); Neuralieve, Inc., Sunnyvale, CA, USA (C.T. Schembri and M. Helmuth); Swedish Clinic, Seattle, WA, USA (S.K. Aurora).
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  • Carol T. Schembri MS,

    1. From Mayo Clinic, Phoenix, AZ, USA (D.W. Dodick); Neuralieve, Inc., Sunnyvale, CA, USA (C.T. Schembri and M. Helmuth); Swedish Clinic, Seattle, WA, USA (S.K. Aurora).
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  • Michele Helmuth RN, MN, CANP,

    1. From Mayo Clinic, Phoenix, AZ, USA (D.W. Dodick); Neuralieve, Inc., Sunnyvale, CA, USA (C.T. Schembri and M. Helmuth); Swedish Clinic, Seattle, WA, USA (S.K. Aurora).
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  • Sheena K. Aurora MD

    1. From Mayo Clinic, Phoenix, AZ, USA (D.W. Dodick); Neuralieve, Inc., Sunnyvale, CA, USA (C.T. Schembri and M. Helmuth); Swedish Clinic, Seattle, WA, USA (S.K. Aurora).
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  • Sources of financial support: Not applicable.

  • Clinical trial registration number: Not applicable.

  • Conflict of Interest: David W. Dodick, MD: Consulting/Honoraria: Allergan, Addex, Alexza, Almirrall, Coherex, Eli Lilly, Endo, GlaxoSmithKline, HS Lundbeck, Kowa, MAP, Medtronic, Merck, Minster, Neuralieve, Neuraxon, Novartis, NuPathe, Pfizer, Nautilus, Zogenix, Boston Scientific Editorial: Wiley-Blackwell (Cephalalgia, Headache Currents); SAGE (Cephalalgia) American College of Physicians (MKSAP Editor); The Neurologist. Research Support: Medtronic, Advanced Neurostimulations Systems, St. Jude, NINDS, Mayo Clinic. Stocks: None. Speakers Bureau: None. Sheena K. Aurora, MD: Grants and Research Support (within last 2 years): Advanced Bionics, Alexza, Allergan, Capnia, GlaxoSmithKline, MAP Pharmaceuticals, Merck and Co, OrthoMcNeil, Neuralieve, NuPathe, Takeda. Consulting: Ortho-McNeil Pharmaceutical, Inc, Merck and Co, GlaxoSmithKline, Allergan, Neuralieve, NuPathe, MA. Honoraria: Merck and Co., GlaxoSmithKline, Kowa, NuPathe, Ortho-McNeil Pharmaceutical, Inc.

D.W. Dodick, Department of Neurology, Mayo Clinic, 1344 E. Shea Blvd, Scottsdale, AZ 85259 USA.

Abstract

(Headache 2010;50:1153-1163)

Objective.— To review potential and theoretical safety concerns of transcranial magnetic stimulation (TMS), as obtained from studies of single-pulse (sTMS) and repetitive TMS (rTMS) and to discuss safety concerns associated with sTMS in the context of its use as a migraine treatment.

Methods.— The published literature was reviewed to identify adverse events that have been reported during the use of TMS; to assess its potential effects on brain tissue, the cardiovascular system, hormone levels, cognition and psychomotor tests, and hearing; to identify the risk of seizures associated with TMS; and to identify safety issues associated with its use in patients with attached or implanted electronic equipment or during pregnancy.

Results.— Two decades of clinical experience with sTMS have shown it to be a low risk technique with promise in the diagnosis, monitoring, and treatment of neurological and psychiatric disease in adults. Tens of thousands of subjects have undergone TMS for diagnostic, investigative, and therapeutic intervention trial purposes with minimal adverse events or side effects. No discernable evidence exists to suggest that sTMS causes harm to humans. No changes in neurophysiological function have been reported with sTMS use.

Conclusions.— The safety of sTMS in clinical practice, including as an acute migraine headache treatment, is supported by biological, empirical, and clinical trial evidence. Single-pulse TMS may offer a safe nonpharmacologic, nonbehavioral therapeutic approach to the currently prescribed drugs for patients who suffer from migraine.

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