Transcranial Magnetic Stimulation for Pain, Headache and co-morbid depression: INS-NANS Expert Consensus Panel Review and Recommendation

Abstract

Background: Persistent Post-Traumatic Brain Injury (PTBI) Related Headache (PTBI-HA) is one of the most common debilitating chronic pain conditions in patients after a mild/moderate traumatic brain injury. Unfortunately, conventional pharmacological treatments for PTBI-HA have not been shown to be effective. Under the guidance of a steering committee composed of International Neuromodulation Society (INS) and the North American Neuromodulation Society (NANS) leadership, this expert panel provided TMS treatment recommendations for the PTBI-HA. Methods: Individual studies were first rated by the guideline established by American Academy of Neurology Classification of Evidence for Therapeutic Studies. The overall clinical evidence was then rated based on Type of Study Design and Level of Certainty, and recommendation was provided based on the US Preventive Service Task Force (USPSTF) and Centers for Disease Control and Prevention (CDC) criteria. Based on the existing clinical outcome evidence for the short-term efficacy (1-2 month) in alleviating PTBI-HA symptoms, the majority of the task group members rated the Study Design as I (Randomized Controlled Trials) for TMS at M1 or left LDLPFC, Level of Certainty in Evidence as High for PTBI-HA. Results/Conclusions: The task group also rated USPSTF recommendation as A (Extremely Recommendable) and CDC recommendation as IA (Strongly Recommended) for the clinical implementation of the rTMS at either M1 or left LDLPFC for mild PTBI-HA with the latter being considered as alternate treatment location for patients with PTBI-HA and co-morbid severe depression.