Long-term Efficacy of Repetitive Transcranial Magnetic Stimulation at Motor Cortex for Mild Traumatic Brain Injury-Related Headaches.

OBJECTIVES: Persistent headaches with frequent debilitating headache exacerbation are some of the most common debilitating chronic pain conditions in either military or civilian populations with mild traumatic brain injury (MTBI). This high prevalence of MTBI-related headaches (MTBI-HA), also known as persistent headache attributed to mild traumatic injury to the head by the International Classification of Headache Disorders, is often associated with neuropsychologic dysfunction in mood, attention, and memory. Thus, MTBI-HA casts a profound, negative impact on patients' quality of life and increases stress in their caregivers. This double-blind, randomized controlled trial aimed to assess the effect of repetitive transcranial magnetic stimulation (rTMS) in reducing both persistent and debilitating headache symptoms and comorbid neuropsychologic impairments. METHODS AND MATERIALS: Ten sessions of active (10 Hz) or sham rTMS were delivered to the left motor cortex (MC) under magnetic resonance imaging-based neuronavigation guidance with headache, cognitive, and mood assessments up to three months post treatment. RESULTS: Overall mixed effect model indicates active rTMS can significantly (p < 0.001) reduce the between-visit frequency of persistent headache and the duration of debilitating headache, respectively, long-term (three-month) and midterm (two-month) posttreatment visits with associated improvement in daily activity and concentration interference, attention and word processing speed, and retention and recall accuracy. CONCLUSIONS: In short, ten sessions of rTMS at the left MC can effectively reduce headache symptoms and interferences of concentration and daily activities. The treatment also can improve concentration and relieve some aspects of cognitive impairment associated with MTBI-HA although the treatment may cause a mild degree of transient short-term persistent headache exacerbation without ongoing maintenance intervention. Future studies should focus on the utilization of maintenance rTMS after the induction treatment phase in sustaining the benefits of the intervention. CLINICAL TRIAL REGISTRATION: The Clinicaltrials.gov registration number for the study is NCT03314584.