Purpose of Review

Management of chronic daily headaches (CDH) remains challenging due to the limited efficacy of standard prophylactic pharmacological measures. Several studies have reported that repetitive transcranial magnetic stimulation (rTMS) can effectively treat chronic headaches. The objective was to determine the utility of rTMS for immediate post-treatment and sustained CDH prophylaxis.

Recent Findings

All procedures were conducted per PRISMA guidelines. PubMed, Scopus, Web of Science, and ProQuest databases were searched for controlled clinical trials that have tested the efficacy of rTMS on populations with CDH. DerSimonian-Laird random-effects meta-analyses were performed using the ‘meta’ package in R to examine the post- vs. pre-rTMS changes in standardized headache intensity and frequency compared to sham-control conditions. Thirteen trials were included with a combined study population of N = 538 patients with CDH (rTMS, N = 284; Sham, N = 254). Patients exposed to rTMS had significantly reduced standardized CDH intensity and frequency in the immediate post-treatment period (Hedges’ g = -1.16 [-1.89, -0.43], p = 0.002 and Δ = -5.07 [-10.05, -0.11], p = 0.045 respectively). However, these effects were sustained marginally in the follow-up period (Hedges’ g = -0.43 [-0.76, -0.09], p = 0.012 and Δ = -3.33 [-5.52, -1.14], p = 0.003). Significant between-study heterogeneity was observed, at least partially driven by variations in rTMS protocols.

Summary

Despite the observed clinically meaningful and statistically significant benefits in the immediate post-treatment period, the prophylactic effects of rTMS on CDH do not seem to sustain with discontinuation. Thus, the cost-effectiveness of the routine use of rTMS for CDH prophylaxis remains questionable.

Registration

Protocol preregistered in PROSPERO International Prospective Register of Systematic Reviews (CRD42021250100)

中文翻译：

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重复经颅磁刺激预防慢性日常头痛的效用：系统评价和荟萃分析

审查目的

由于标准预防药理学措施的功效有限，慢性日常头痛 (CDH) 的治疗仍然具有挑战性。多项研究表明，重复经颅磁刺激（rTMS）可以有效治疗慢性头痛。目的是确定 rTMS 在治疗后立即和持续 CDH 预防中的效用。

最近的发现

所有程序均按照 PRISMA 指南进行。在 PubMed、Scopus、Web of Science 和 ProQuest 数据库中搜索了测试 rTMS 对 CDH 人群疗效的对照临床试验。使用 R 中的“meta”包进行 DerSimonian-Laird 随机效应荟萃分析，以检查与假手术对照条件相比，rTMS 后标准化头痛强度和频率的变化。13 项试验纳入了 N = 538 名 CDH 患者的联合研究人群（rTMS，N = 284；Sham，N = 254）。接受 rTMS 治疗的患者在治疗后立即显着降低了标准化 CDH 强度和频率（Hedges' g = -1.16 [-1.89, -0.43]，p = 0.002 和 Δ = -5.07 [-10.05, -0.11]， p 分别 = 0.045）。然而，这些影响在随访期间略有持续（Hedges' g = -0.43 [-0.76, -0.09], p = 0.012 和 Δ = -3.33 [-5.52, -1.14], p = 0.003）。观察到显着的研究间异质性，至少部分是由 rTMS 方案的变化造成的。

概括

尽管在治疗后立即观察到具有临床意义和统计学意义的益处，但 rTMS 对 CDH 的预防作用似乎不会随着停药而持续。因此，常规使用 rTMS 预防 CDH 的成本效益仍然值得怀疑。

登记

方案已在 PROSPERO 国际前瞻性系统评价登记册中预注册 (CRD42021250100)