Börner Corinna, Renner Tabea, Trepte-Freisleder Florian, Urban Giada, Schandelmaier Paul, Lang Magdalena, Lechner Matthias F, Koenig Helene, Klose Birgit, Albers Lucia, Krieg Sandro M, Baum Thomas, Heinen Florian, Landgraf Mirjam N, Sollmann Nico, Bonfert Michaela V
Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität, Munich, Germany.
Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Front Neurol. 2022 Jul 28;13:919623. doi: 10.3389/fneur.2022.919623. eCollection 2022.
Repetitive neuromuscular magnetic stimulation (rNMS) of the trapezius muscles showed beneficial effects in preventing episodic migraine. However, clinical characteristics that predict a favorable response to rNMS are unknown. The objective of this analysis is to identify such predictors.
Thirty participants with a diagnosis of episodic migraine (mean age: 24.8 ± 4.0 years, 29 females), who were prospectively enrolled in two non-sham-controlled studies evaluating the effects of rNMS were analyzed. In these studies, the interventional stimulation of the bilateral trapezius muscles was applied in six sessions and distributed over two consecutive weeks. Baseline and follow-up assessments included the continuous documentation of a headache calendar over 30 days before and after the stimulation period, the Migraine Disability Assessment Score (MIDAS) questionnaire (before stimulation and 90 days after stimulation), and measurements of pain pressure thresholds (PPTs) above the trapezius muscles by algometry (before and after each stimulation session). Participants were classified as responders based on a ≥25% reduction in the variable of interest (headache frequency, headache intensity, days with analgesic intake, MIDAS score, left-sided PPTs, right-sided PPTs). univariate and multivariate binary logistic regression analyses were performed.
Lower headache frequency ( = 0.016) and intensity at baseline ( = 0.015) and a migraine diagnosis without a concurrent tension-type headache component ( = 0.011) were significantly related to a ≥25% reduction in headache frequency. Higher headache frequency ( = 0.052) and intensity at baseline ( = 0.014) were significantly associated with a ≥25% reduction in monthly days with analgesic intake. Lower right-sided PPTs at baseline were significantly related to a ≥25% increase in right-sided PPTs ( = 0.015) and left-sided PPTs ( =0.030). Performance of rNMS with higher stimulation intensities was significantly associated with a ≥25% reduction in headache intensity ( = 0.046).
Clinical headache characteristics at baseline, the level of muscular hyperalgesia, and stimulation intensity may inform about how well an individual patient responds to rNMS. These factors may allow an early identification of patients that would most likely benefit from rNMS.
对斜方肌进行重复性神经肌肉磁刺激（rNMS）在预防发作性偏头痛方面显示出有益效果。然而，预测rNMS良好反应的临床特征尚不清楚。本分析的目的是确定此类预测因素。
对30名诊断为发作性偏头痛的参与者（平均年龄：24.8±4.0岁，29名女性）进行分析，这些参与者前瞻性地纳入了两项评估rNMS效果的非假对照研究。在这些研究中，对双侧斜方肌进行介入性刺激，共6次，分连续两周进行。基线和随访评估包括在刺激期前后连续记录30天的头痛日历、偏头痛残疾评估量表（MIDAS）问卷（刺激前和刺激后90天），以及通过痛觉计测量斜方肌上方的疼痛压力阈值（PPTs）（每次刺激前后）。根据感兴趣变量（头痛频率、头痛强度、服用镇痛药天数、MIDAS评分、左侧PPTs、右侧PPTs）降低≥25%将参与者分类为反应者。进行单变量和多变量二元逻辑回归分析。
基线时较低的头痛频率（P = 0.016）和强度（P = 0.015）以及无并发紧张型头痛成分的偏头痛诊断（P = 0.011）与头痛频率降低≥25%显著相关。基线时较高的头痛频率（P = 0.052）和强度（P = 0.014）与每月服用镇痛药天数降低≥25%显著相关。基线时较低的右侧PPTs与右侧PPTs（P = 0.015）和左侧PPTs（P = 0.030）增加≥25%显著相关。较高刺激强度的rNMS操作与头痛强度降低≥25%显著相关（P = 0.046）。
基线时的临床头痛特征、肌肉痛觉过敏水平和刺激强度可能有助于了解个体患者对rNMS的反应程度。这些因素可能有助于早期识别最可能从rNMS中获益的患者。
