Single-pulse transcranial magnetic stimulation

A non-drug option for prevention and acute treatment of migraine

Introduction

Single-pulse transcranial magnetic stimulation (sTMS) is a safe, non invasive and non-drug migraine treatment option. It involves placing the sTMS device against the back of the head for less than a second to deliver a very brief pre-set magnetic pulse. sTMS is designed for self-administration and self-management at home, work and on the go.

sTMS mini Photo

Is sTMS right for me?

Medications may not be the right treatment for everyone with migraine. Many patients have multiple co-morbidities that can make drug interactions a major problem. Patients of childbearing age may choose to avoid medications. Patients with heart disease are advised not to take triptans and simple painkillers may not work.  sTMS provides an effective alternative when medications may not be effective, are not tolerated or are contra-indicated.

How does sTMS work to relieve and prevent migraine?

The sTMS mini is placed at the back of the head for less than a minute, generating a focused, single magnetic pulse that induces a mild electric current at the back of the brain. The number of pulses can be repeated as prescribed by a neurologist. Without discomfort, the pulse generates mild currents in the brain tissue that are believed to interrupt the brain activity associated with migraine.

sTMS is an advanced migraine treatment system that can work without medications and causes no serious side effects.

sTMS mini Patient treating device at back of head

Availability of sTMS

In January 2014 the National Institute for Health and Care Excellence (NICE) published guidance on transcranial magnetic stimulation for treating and preventing migraine.

NICE recommends that sTMS should only be used for the treatment of migraine under the care of a headache specialist. You can learn more about being referred to a specialist in our migraine clinics information.

NHS funding for sTMS can be considered by a CCG through an Individual Funding Request (IFR) or a Neuromodulation Service Development Programme. For all new sTMS patients, NHS funding is available at the Neuromodulation Clinic at Guys & St Thomas’s NHS Trust and requires a GP referral. Access is available to all patients within England. Alternatively, patients may self-fund this treatment.

sTMS scientific evidence

Evidence from clinical trials has shown that sTMS can reduce the severity and/or frequency of migraine attacks in some people:

A multicenter randomised controlled trial of sTMS in 164 patients who had migraine with aura reported 39% patients with pain-free levels at two hours. The pain-free rate at 24 hours was 29% and at 48 hours 27%. In a separate study, three-quarters of patients with migraine who treated repeatedly with sTMS had a reduction in headache frequency, even those with chronic migraine. The results are both statistically significant and clinically meaningful.1

A UK post market pilot programme with sTMS showed that of the 190 patients surveyed 62% reported pain relief. At three months, there was reduction in monthly headache days for episodic migraine from 12 to 9 days and for chronic migraine, a reduction from 24 to 16 days. A reduction in the number of headache days per attack was reported in 102 of 185 patients reporting duration data at 12 weeks. The average reduction was a mean decrease from 2.2 days to 0.7 days per attack. There were no serious or unanticipated adverse events.2

A post market observation U.S. study of migraine (ESPOUSE study) was conducted at eight leading U.S. headache centers on 132 migraine patients. Patients following the protocol of daily use of the sTMS device reported an average reduction from nine headache days per month to six days post treatment. There were no serious adverse events reported during the study.3

A health economics paper compared the annual cost to the NHS of patients using Botulinum toxin type A by injection (Botox®) to those using sTMS for the treatment of chronic migraine.  The study found that the extended annual cost for patients for whom the sTMS is effective (53.7%) is significantly less (£386) for sTMS (£1361) than those who receive quarterly Botox treatments (£1747).4

References

  1. Lipton, R. B., Dodick, D.W., Silberstein, S.D., Saper, J.R., Aurora, S.K., Pearlman, S.H., Fischell, R.E., Ruppel, P.L., Goadsby, P.J. (2010). Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: a randomized, double-blind, parallel-group, sham controlled trial. Lancet Neurology, 9(4):373-380. Doi: 10.1016/s1474-4422(1)70054-5.
  2. Bhola, R., Kinsella, E., Ahmed, F., Goadsby, P.J. (2014). Update of the UK post market pilot programme with single pulse transcranial magnetic stimulation (sTMS) for acute treatment of migraine. The Journal of Headache and Pain, 15 (suppl 1), M2. Doi: 10.1186/1129-2377-15-S1-M2.
  3. Starling, A.J., Tepper, S., Marmura, M.J., Shamim, E.A., Robbins, M., Hindiyeh, N., Charles, A.C., Goardsby, P.J., Lipton, S.D., Silberstein, S.D., and Dodick, D.W. (2017). A Multicenter, Prospective, Single Arm, Open Label, Post-Market, Observational Study to evaluate the use of sTMS in reduction of Migraine Headache (ESPOUSE Study). Abstract presented at the 69th Annual meeting of the American Association of Neurology held in Boston, Massachusetts.
  4. Bruggenjurgen, B., Baker, T., Bhogal, R., and Ahmed, F. (2016). Cost impact of a non-invasive, portable device for patient self-administration of chronic migraine in a UK National Health Service setting.  SpringerPlus, 5:1249. Doi: 10.1186/s40064-016-2924-8.