IRCCS Centro Neurolesi Bonino Pulejo-Piemonte, 98124 Messina, Italy.
Istituto Clinico Polispecialistico, C.O.T. Cure Ortopediche Traumatologiche s.p.a., 98124 Messina, Italy.
J Integr Neurosci. 2022 Jun 7;21(4):110. doi: 10.31083/j.jin2104110.
Transcranial magnetic stimulation (TMS), a non-invasive brain stimulation method, is trying to emerge as a migraine management strategy for both attack treatment and prevention. This scoping review presents 16 among single-pulse (to manage episodic and chronic migraine) and repetitive TMS randomized clinical trials (to manage chronic migraine). The works we reviewed suggest that TMS may be adopted as add-on therapy in those patients who are refractory to pharmacological therapy only with special arrangements for individualized treatment strategies or research. There are still limited clinical research programs and metaanalysis to promote routinely TMS employment, as TMS has been shown either to have no significant effects for any outcome or to be effective for migraine. These diverging conclusions depend on several biasing factors, including the lack of reliable, large, sham-controlled clinical trials, the dyshomogeneity in study designs (including the area of stimulation, the frequency of stimulation, the number of pulses, pulse intensity, and the number of sessions), patient selection criteria (migraine w/o aura, episodic and chronic migraine; TMS contraindication), and the lack of outcomes homogeneity and long-term real-world efficacy data. Therefore, in the future, it will be important to conduct larger randomized trials to confirm TMS usefulness in migraine management (acute attack and prophylactic treatment), identify those patients who may benefit from TMS, maybe independently of pharmacological treatments (i.e., using TMS as an alternative and not only as an add-on treatment). Otherwise, TMS will play a role in treating migraine only with special arrangements for individualized management strategies or research.
经颅磁刺激（TMS）是一种非侵入性的脑刺激方法，它正试图成为一种偏头痛管理策略，既可以用于治疗发作，也可以用于预防。本范围综述介绍了 16 项单脉冲（用于治疗发作性和慢性偏头痛）和重复 TMS 随机临床试验（用于治疗慢性偏头痛）。我们回顾的研究表明，TMS 可能被采用为附加治疗，适用于仅对药物治疗有抗性的患者，需要特殊安排个体化治疗策略或研究。由于 TMS 要么对任何结果都没有显著影响，要么对偏头痛有效，因此，仍需要进行更多的临床研究计划和荟萃分析来促进常规 TMS 的应用。这些相互矛盾的结论取决于几个偏倚因素，包括缺乏可靠的、大型的、假刺激对照临床试验、研究设计的不均匀性（包括刺激区域、刺激频率、脉冲数、脉冲强度和疗程数）、患者选择标准（无先兆偏头痛、发作性和慢性偏头痛；TMS 禁忌症），以及缺乏结局的均匀性和长期真实世界疗效数据。因此，未来开展更大规模的随机试验以确认 TMS 在偏头痛管理（急性发作和预防性治疗）中的有效性，确定那些可能受益于 TMS 的患者，也许可以独立于药物治疗（即，将 TMS 作为替代治疗，而不仅仅是附加治疗）将是很重要的。否则，TMS 将仅在特殊安排个体化管理策略或研究中发挥治疗偏头痛的作用。
