Clinical study of high frequency repetitive transcranial magnetic stimulation in chronic tension-type headache / 中华神经医学杂志

ABSTRACT

Objective:To observe the efficacy and safety of high frequency repetitive transcranial magnetic stimulation (rTMS) in the treatment of chronic tension-type headache (CTTH) patients.Methods:Thirty-eight patients with CTTH, admitted to our hospital from February 2019 to September 2021, were randomly divided into rTMS group and control group ( n=19). In the rTMS group, the hot spot of the right abductor pollicis brevis was surface-labeled and the resting movement threshold (RMT) was calculated; the intensity of the stimulus was then adjusted to 70% of RMT, and stimulus was then located at 5 cm in front of the previously identified hot spot of the right thumb, namely the left dorsolateral prefrontal cortex (LDLPFC); the stimulus was delivered once every Monday, Wednesday and Friday, and lasted for 4 weeks with 12 rounds of stimulation. In the control group, the hot spot was not located and RMT was not calculated; the coil was placed perpendicular to LDLPFC; and the stimulation frequency was the same as that in the rTMS group with minimum stimulation intensity. Visual analogue scale (VAS), Headache Impact Test-6 (HIT-6), simplified McGill Pain Questionnaire (SF-MPQ) were used to evaluate the subjective pain status. The electrophysiological indices in the nociceptive flexion reflex (NFR) and conditioned pain modulation (CPM) were used to evaluate the objective pain status. Adverse events during treatment and 1-month follow-up were recorded in the two groups. Results:(1) Rating scales: scores of all rating scales in the rTMS group after treatment were significantly decreased as compared with those before treatment ( P <0.05); however, no significant difference was noted in the control group ( P>0.05). After treatment, the scores of VAS, HIT-6, present pain intensity (PPI) scale, and trait anxiety inventory in the rTMS group were significantly decreased as compared with those in the control group ( Z=-4.054, P<0.001; t= -6.083, P<0.001; Z=-4.246, P<0.001; Z=-3.740, P<0.001). (2) NFR RIII parameters: as compared with that before treatment, the minimum threshold in rTMS group after treatment was significantly increased ( P<0.05). There were no significant differences in NFR RIII parameters in the control group between those after treatment and before treatment ( P>0.05). After treatment, the minimum NFR minimumthreshold in the rTMS group was significantly increased as compared with that in the control group ( P<0.05). Cold compression test results showed that as compared with basic NFR RIII area, NFR RIII area before and after treatment in both rTMS group and control group was statistically increased ( P<0.05). (3) Adverse reactions: no serious adverse reactions occurred in the two groups during treatment and follow-up. Conclusion:Treatment with rTMS in CTTH patients enjoys good short-term efficacy without obvious adverse reactions.