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. 2023 Oct 30;10(11):1764.
doi: 10.3390/children10111764.

Neuromodulation in Pediatric Migraine using Repetitive Neuromuscular Magnetic Stimulation: A Feasibility Study

Corinna Börner-Schröder  1   2   3   4 , Magdalena Lang  1   2 , Giada Urban  1   2 , Erik Zaidenstadt  1   2 , Jacob Staisch  1   2 , Ari Hauser  1   2 , Iris Hannibal  1   2 , Kristina Huß  2 , Birgit Klose  1   2 , Matthias F Lechner  1   2 , Nico Sollmann  3   4   5 , Mirjam N Landgraf  1   2 , Florian Heinen  1   2 , Michaela V Bonfert  1   2
Affiliations

Neuromodulation in Pediatric Migraine using Repetitive Neuromuscular Magnetic Stimulation: A Feasibility Study

Corinna Börner-Schröder et al. Children (Basel). .

Abstract

Migraine has a relevant impact on pediatric health. Non-pharmacological modalities for its management are urgently needed. This study assessed the safety, feasibility, acceptance, and efficacy of repetitive neuromuscular magnetic stimulation (rNMS) in pediatric migraine. A total of 13 patients with migraine, ≥6 headache days during baseline, and ≥1 myofascial trigger point in the upper trapezius muscles (UTM) received six rNMS sessions within 3 weeks. Headache frequency, intensity, and medication intake were monitored using headache calendars; headache-related impairment and quality of life were measured using PedMIDAS and KINDL questionnaires. Muscular involvement was assessed using pressure pain thresholds (PPT). Adherence yielded 100%. In 82% of all rNMS sessions, no side effects occurred. All participants would recommend rNMS and would repeat it. Headache frequency, medication intake, and PedMIDAS scores decreased from baseline to follow-up (FU), trending towards statistical significance (p = 0.089; p = 0.081, p = 0.055). A total of 7 patients were classified as responders, with a ≥25% relative reduction in headache frequency. PPT above the UTM significantly increased from pre- to post-assessment, which sustained until FU (p = 0.015 and 0.026, respectively). rNMS was safe, feasible, well-accepted, and beneficial on the muscular level. The potential to reduce headache-related symptoms together with PPT changes of the targeted UTM may underscore the interplay of peripheral and central mechanisms conceptualized within the trigemino-cervical complex.

Keywords: myofascial trigger point; neurostimulation; pain pressure threshold; primary headache; responder rate.

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Conflict of interest statement

The Division of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children’s Hospital, LMU Hospital, Munich Germany was provided by an emFieldPro magnetic stimulator by Zimmer MedizinSysteme GmbH (Neu-Ulm, Germany). N.S. received honoraria from Nexstim Plc (Helsinki, Finland). M.N.L. and F.H. received a grant “Innovationsfonds” of the joint federal committee of health insurance companies (GBA) for a nation-wide study on an early multimodal intervention program for children with migraine. No further conflicts of interest are reported. MVB’s research concerning neuromodulation in migraine is supported by a scholarship of the Bavarian Gender Equality Grant of the Free State of Bavaria, Germany. MVB’s research concerning pediatric mTBI is supported by the ZNS-Hannelore Kohl Stiftung. MVB’s and NS’ research on rNMS in adult migraine are supported by a research grant of the Deutsche Migräne- und Kopfschmerzgesellschaft (DMKG).

Figures

Figure 1
Figure 1
Clinical setup of rNMS treatment. (A) rNMS setting and coil positioning. (B) Stimulation protocol used for the rNMS treatments. Since 53 trains could not be visualized individually, which is why the repetition of trains is marked with […]. Abbreviation: rNMS = repetitive neuromuscular magnetic stimulation.
Figure 2
Figure 2
Screening scheme for study inclusion.
Figure 3
Figure 3
Comparison of PedMIDAS categories before and after rNMS treatment. Abbreviations: rNMS = repetitive neuromuscular magnetic stimulation, pre = before treatment, post = after treatment, PedMIDAS = Pediatric Migraine Disability Assessment.
Figure 4
Figure 4
Comparison of PPT prior the first rNMS session, prior the last rNMS session, and at the 3-month FU examination. PPT above the left and right UTM were calculated based on the average of PPT above the lateral and medial reference points as well as the mTrP. Boxplots display the median PPT as well as the IQR. Significant differences are marked with an asterisk (*). Abbreviations: PPT = pressure pain threshold, mTrP = myofascial trigger point, pre = prior to the first rNMS session, post = prior to the last rNMS session, FU = follow-up, IQR = interquartile range.
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