Severe headache pain, sensitivity to light, and nausea are just a few of the many symptoms associated with migraine, a common neurological condition.
If you live with migraine, you may often reach for pain medication when you feel an episode coming on to help prevent or relieve migraine symptoms. Other preventive therapies have also been developed to help manage symptoms.
Transcranial magnetic stimulation (TMS) is a type of noninvasive therapy to help prevent or reduce severe migraine symptoms. It’s also called repetitive transcranial magnetic stimulation (rTMS), as multiple sessions are needed.
In TMS, electromagnetic pulses or waves stimulate the brain’s nerve cells. It targets the outer part of the brain called the cortex. Magnetic fields create a small electrical current that activates certain nerves, thereby making a person less likely to have a migraine episode with TMS.
People with migraine can receive TMS therapy in clinics, doctors’ offices, or in an outpatient setting. The FDA has approved one TMS device for in-home use for migraine prevention. This is known as sTMS (or single-pulse TMS).
A doctor will need to prescribe this treatment if it’s suitable for you.
The process for getting TMS varies depending on the provider. There’s no universal protocol for in-office treatment at this time.
- You will likely begin with an intake appointment, where you may be asked to complete surveys, have measurements taken, and go over your medical history in detail.
- This is often followed by an EEG (electroencephalogram), a scan that looks for what areas on the outer surface of the brain have the most electrical (nerve) activity. This mapping will be used to apply the TMS therapy where it’s needed most.
- Next, the medical professional or technician will “map” your brain. This will be kept in your medical file for your future treatments. They will also customize the treatment strength or setting based on your tests.
- Once the initial assessments are completed, you can begin TMS treatment sessions. Each session can last for around 20 minutes and you may need several sessions.
There’s typically no pain associated with TMS other than a mild tapping sensation and you’ll be wearing earplugs during treatment due to the noise of the machine.
TMS is a noninvasive procedure, so you’ll be awake during the therapy and you can safely drive home afterward. You also won’t need anesthesia or numbing of any kind.
Chronic migraine is when a person has 15 or more days of symptoms per month. This can be debilitating and decrease quality of life for people with migraine.
A study in 2021 suggests that TMS may reduce the number of migraine episodes, the severity of pain associated with migraine, and the duration of episodes.
A study in 2022 states that TMS therapy may reduce pain severity, as well as the number of episodes by up to 8 days a month.
TMS was found to work for migraine episodes that occurred with and without aura. The same studies found that TMS was effective for people of all ages who have migraine.
But it’s important to note that because in-office TMS treatments vary, so does the effectiveness. It can sometimes depend on the provider.
A note on race
The American Migraine Foundation (AMF) notes that People of Color are largely underrepresented in studies about migraine, including TMS research.
According to surveys by the AMF, only 46 percent of Black people with migraine reported that they would pursue medical treatment compared to 72 percent of white people. This may be due to economic issues, social determinants of health, access to medical care, medical mistrust, health inequities, and discrimination and unconscious bias.
Always check with your doctor before starting a new therapy or treatment for migraine pain. Some people with migraine will not be able to receive TMS treatment since it’s not suitable for everyone.
While side effects during and after TMS treatments are typically minor, they can happen.
Side effects may include:
- nerve twitching or a vibrating sensation around the head and face area
- headache or tenderness after the treatment
About a third of people experience some headache pain or facial twitching.
The most serious side effect of TMS is a seizure. However, this is rare.
You will need to remove all jewelry and metal on your body or clothing before TMS because the therapy uses magnetic pulses. For the same reason, if you have metal implants of any kind in the head, you may not be able to have TMS therapy.
You may be a good candidate for TMS If you have tried other medications and therapies to manage migraine symptoms without success.
You should avoid TMS if you have any kind of metal implant in the head area (aside from braces and dental fillings). These include:
- a metal plate or any other foreign metal piece in your head
- implanted devices like a brain stimulator
- metal clips or coils for an aneurysm
- facial tattoos with magnetic or metallic ink
TMS is not recommended for people who experience seizures or epilepsy, or anyone with other current medical conditions that pose a risk of seizures.
TMS is used to help prevent or treat medical conditions other than migraine, including:
- obsessive-compulsive disorder (OCD)
- seizures (even though TMS can negatively affect some people with seizures, it’s
used to treat them inothers)
- attention deficit hyperactivity disorder (ADHD)
- post-traumatic stress disorder (PTSD)
- stroke rehabilitation
- chronic pain
The Food and Drug Administration (FDA) has approved TMS to be used as a treatment for depression, especially in people who do not respond well to other treatments like antidepressant medications. Additionally, TMS may be an effective alternative therapy for certain symptoms of fibromyalgia.
TMS is not currently FDA-approved for treating all the conditions above. The effectiveness of this treatment also varies depending on the condition and the provider.
Research is more robust for TMS in the treatment of psychiatric conditions, as opposed to other conditions.
If you have chronic migraine symptoms and have not experienced relief from prescription medications and other therapies for migraine, ask your doctor about TMS.
If you do not have a neurologist, your primary care doctor can refer you to one. Both a primary doctor and a neurologist may be able to help get you started with TMS treatments if they believe it’s right for you.
You may need to visit an independent or private TMS clinic if your doctor’s office or hospital does not offer it. Call your health insurance company to find out if it covers this type of treatment before beginning TMS sessions.
TMS has become an alternative treatment option for several medical conditions. Clinical studies indicate that it may be an effective preventive therapy for migraine.
This noninvasive treatment may help reduce migraine pain and the frequency of migraine episodes per month. Talk with your primary doctor or neurologist to find out if TMS may be right for you.