Headache Currents

Transcranial Magnetic Stimulation: Basic Principles and Clinical Applications in Migraine

Anthony T. Barker PhD, FIET, FIPEM

Corresponding Author

Anthony T. Barker PhD, FIET, FIPEM

Consultant Clinical Scientist in the Department of Medical Physics and Clinical Engineering at Sheffield Teaching Hospitals NHS Foundation Trust, Professor Associate at the University of Sheffield Medical School, UK

Address all correspondence to: Corresponding Author (Basic Principles): Anthony T. Barker, PhD, email: [email protected]; Corresponding Author (Clinical Applications): Kevin Shields, MB, PhD, MRCPI, email: [email protected]Search for more papers by this author
Kevin Shields MB, PhD, MRCPI

Kevin Shields MB, PhD, MRCPI

Consultant Neurologist and Clinical Neurophysiologist at The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK

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First published: 28 December 2016
Citations: 64

Conflict of Interest: Both authors are paid scientific advisors for eNeura. Dr Barker is a Scientific Advisor to the Magstim Company, Ltd, in addition to his work with eNeura. Dr Shields has no other consultancies to report.

Financial support for research. Drs Barker and Shields are scientific advisors to eNeura (see Disclosures). They are compensated for their counsel.

Disclosures: Drs Barker and Shields serve as scientific advisors to eNeura (Sunnyvale, CA, USA) and are compensated for their counsel. eNeura is the manufacturer of the SpringTMS®, a portable single-pulse transcranial magnetic stimulation device. In the US, it is indicated for the treatment of pain associated with migraine headache with aura. In the UK, the SpringTMS is intended for therapeutic treatment and prevention of migraine headache.

Headache registration policy of the ICMJE. Not applicable since no new original research is reported here.

Abstract

Purpose

Transcranial magnetic stimulation (TMS) is a neurophysiological technique with a long established pedigree of safety, tolerability, and efficacy. Initially TMS was used to study the function of the cerebral cortex, but it has now become a treatment for migraine, one of the most common and debilitating neurological conditions. In this review we discuss the scientific background and development of the technique. We explore its application for the treatment of migraine and ponder the possible mechanisms of action in this most common neurological condition.

Overview: The generation of brief magnetic pulses by a suitable coil can induce electrical fields in the body. When applied to the cerebral cortex, currents are painlessly induced in cortical neurons. These currents can lead to neuronal depolarization and may influence cortical excitability by means that are as yet not fully understood. This ability to modulate cortical excitability has been exploited as a treatment for migraine with aura. Aura is implicated in the pathophysiology of migraine. Experimental studies have shown that transcranial magnetic pulses can block waves of cortical spreading depression – the experimental equivalent of migrainous aura.

Discussion

Migraine is a debilitating condition characterized by headache, nausea, and sensory hypersensitivity. It may affect up to 15% of the population, yet current drug treatments are often poorly tolerated. Clinical studies have shown that TMS is an effective treatment for migraine. In addition, it has the added advantages of being safe and well tolerated by patients.