Transcranial Magnetic Stimulation (TMS)

One of the most exciting developments in future migraine care, Transcranial Magnetic Stimulation (TMS) is a method of stimulating the brain using electromagnets. The theory behind using TMS with migraine care is that, according to research, the brains of migraine patients tend to have different levels of excitability during migraine attacks, as opposed to when the migraineur is attack free.

TMS can both investigate changes in brain activity as well as excite areas of the brain. Currently being used to diagnose diseases such as stroke and multiple sclerosis and to research the impact of neurological conditions like migraine on the brain, TMS has the potential to also be used therapeutically in the future.

History and Mechanism

The idea of using electromagnetic induction to influence brain activity has been around for hundreds of years. Since at least the eighteenth century, scientists have been experimenting with electromagnets and electric currents. That research led to the idea of using electrodes to stimulate muscles; by the mid-nineteenth century, physicians such as Roberts Bartholow began to make headway in using electric currents to excite areas of the human brain. Further research and experiments were conducted over the years, with some of the first distinctly TMS therapies occurring in the 1980s.

When TMS is used as therapy, magnetic pulses are created with an electromagnet attached to the patient's scalp. Pulses are sent in one of two methods: single or repetitive. Single short pulses stimulate the cerebral cortex, thereby altering patterns of brain activity for short periods of time. Repetitive pulses (rTMS) have the tendency to produce longer-acting effects.

TMS is considered a noninvasive procedure. Anesthesia is not used, and the electromagnet is painlessly attached to the scalp. Patients who have received TMS report hearing a slight tapping sound. Muscle contraction is another side effect, as the brain stimulation can affect areas in the scalp, face, and jaw.

While a small number (5 to 10 percent) of patients experienced discomfort at the site where the electromagnet was attached, most reported the experience to be pain free. When used therapeutically, most patients received daily half-hour sessions. These sessions were maintained for anywhere between two to six weeks.

Is Transcranial Magnetic Stimulation only considered beneficial to migraine sufferers?

No, TMS is being researched for its application to many illnesses. In addition to migraine, early studies have shown the possibility for TMS to be helpful in treating depression, hallucination, Parkinson's disease, and tinnitus.

Potential Risks and Treatment

Because of the nature of the brain stimulation, TMS has the potential to cause seizures. However, this incidence is rare (especially with low-frequency doses), and there have not been serious cases of seizure reported. However, since TMS is not an FDA-approved procedure as of this writing, joining a trial or volunteering for research are the only ways to currently take advantage of TMS treatment.

Preliminary studies conducted at Ohio State University showed that TMS had the ability to significantly (by up to 69 percent) reduce the pain and intensity of an active migraine attack. This study also showed that after receiving TMS, migraine sufferers reported significantly less sensitivity to noise and light, in addition to being relieved of their nausea. Further research is required in order to prove a definitive correlation between migraine relief and TMS, but early studies look promising.

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