Transcranial Magnetic Stimulation service at Guy’s and St Thomas’ NHS Foundation Trust

Could Transcranial Magnetic Stimulation be the treatment for you?

Abortive and preventive migraine treatments are still limited by their poor tolerability profile and potential side effects, which contraindicate their use in a significant proportion of migraine sufferers. There is therefore a need for novel effective and well-tolerated treatments

What is TMS?
Single pulse Transcranial Magnetic Stimulation (SpringTMS®) is a non-invasive neuromodulation therapy, which uses magnetic fields in order to deliver small electrical currents to the outer surface of the brain (the cortex). These pulses can help to reduce over-excitability in this area and dampen down the amplification of pain signals in the brain during a migraine.

Single pulse TMS can be used acutely to abort or reduce the severity of an episode in people with migraine with aura. It can also be used at planned daily intervals with the intention of reducing the frequency and/or severity of subsequent migraine episodes. “This treatment has been shown in experimental studies to be able to block the process that leads to hypersensitivity of the brain during migraine with aura. This mechanism may explain the efficacy of sTMS in migraine with and without aura”, says Dr Anna Andreou, Director of the Headache Research at the Headache Centre, Guy’s and St Thomas’ Hospitals.

sTMS in migraine is delivered using a portable handheld device that provides a predetermined level of magnetic pulse to the head. The device is placed on the scalp, at the back of the head, and sTMS magnetic pulses are delivered at the press of a button. The intensity and duration of the pulse are predetermined. The interval times of each sTMS pulse will be discussed with your headache doctor.  Treatments may be automatically recorded by the device in an integrated headache diary, which can be used to identify headache patterns and trigger factors. Patients may continue to use regular medications, including drugs to prevent migraines in accordance with the treatment plan they received from their doctor.

Results from randomised control trials and post-market analysis studies suggest that sTMS can have a good effect in 40% of the patients, similar to the efficacy of current drug therapies. It may also eliminate or reduce the patient’s need for acute medications. sTMS treatment may have a particular role in the reduction or avoidance of drug therapy, either where preferred, or where drug therapy is contraindicated or best avoided (for example, in pregnancy).

sTMS clinic at the GSTT Headache Centre

The National Institute for Health and care Excellence (NICE) in the UK encourages the use of non-invasive neurostimulation techniques such as sTMS for the treatment of chronic and episodic migraine. In view of its advantageous safety profile and initial evidence of efficacy in migraine, the Headache Centre at Guy’s and St Thomas’ Hospital, led by Dr Giorgio Lambru (Consultant Neurologist) has set up an sTMS service in the UK, which has been granted commissioning on the NHS for selected patients with migraine. To date, this is the only headache service in UK that can provide this treatment on the NHS.

“Too many migraine sufferers still suffer due to poor tolerability of their current treatment. We are very pleased to be able to offer this new treatment to some of our migraine sufferers. sTMS is a non-invasive, safe, well-tolerated and easy-to-use treatment, with some good evidence of effectiveness in the acute and preventive treatment of migraine” says Dr Giorgio Lambru.  Sufferers will have to be referred to the GSTT Headache Centre and their eligibility for sTMS will be assessed by a headache specialist. “Our sTMS clinic has been so far very successful and we hope we will be able to help more migraine patients in the future”.

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