How does the TMS device work?
Dr. Mohammad: I would like to start with a summary about migraine headache. It is a common disorder that afflicts 18 percent of the female population and 6 percent of the male population. At any time there are around 25 to 30 million American that suffer from migraine headaches. The attacks are commonly debilitating. Current treatment for migraine attacks includes the migraine specific medications such as Imitrex, Relpax, Maxalt, Frova etc. Unfortunately, only 50 percent of migraine patients respond to them. Moreover, some patients either cannot tolerate the adverse reaction of these medications or they are contraindicated in their condition. For example, patients with a history of heart disease or stroke, or patients with uncontrolled hypertension, these medications are contraindicated. Many patients resort to frequent consumption of analgesics and narcotics and end up with either dependency to these medications or develop analgesic rebound headache. So, in summary there is a need for an alternative.
How did TMS come into the picture?
Dr. Mohammad: For many years, scientists believed in the vascular theory behind the mechanism for migraines; in other words, the blood vessels constrict or narrow and the brain reacts to this process by dilating the blood vessels. This is when the patient will have the throbbing, pounding, pulsating headache; however, in the last few years there is a new understanding on how migraines start. Most scientists now believe migraines starts with some kind of electrical storm or electrical activity that starts at the back of the brain and this is manifested by the patients as flashing light, zigzag light, bright spots or bright stars in their vision. This process of electrical storm/activity spreads and propagates throughout the brain. The end process is the throbbing, pounding, pulsating headache. Because of this new understanding of how migraines start, which is electrical in nature, the theory was maybe we can interrupt this electrical process by two pulses of magnetic field before it leads to the headache. This was the idea behind the TMS study. The trial was a large multicenter study. Patients were randomized to either the hand-held, small transcranial magnetic device that the size of a hair dryer or to an identical device that produces a placebo or sham pulses. A total of 164 patient was randomized to either the TMS device or the sham device. Thirty-nine percent of the patients that received the magnetic pulses were headache-free at two hours compared to 22 percent of the patients that received the sham pulses. These results are very encouraging because no medication achieved this efficacy before.
So this is more effective than medication?
Dr. Mohammad: Yes, that is correct regarding the pain free efficacy. As I mentioned, 39 percent of the patients that had the magnetic pulses were headache free after two hours.
Is this only for patients who get aura migraines?
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Migraine treatment
The new treatment is only for patients who get aura migraines.
 
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Dr. Mohammad: Yes. Around 25 to 30 percent of migraine patients their headaches are preceded by an aura, which as I mentioned, is a flashing light, zigzag light, or bright spots or stars in their vision. The study was done in patients that have an aura preceding their headaches. So yes, the device was shown effective in patients that have migraine headache with aura. Having said that, another study is currently in progress to evaluate the efficacy of TMS in migraine patients without aura. We have to wait for the results of this study.
How exciting are you to have this additional treatment option for patients?
Dr. Mohammad: It is a landmark in the history of migraine treatment. As I mentioned, migraine headache is extremely prevalent. At any point, 25 to 30 million individuals in the United States suffers from migraine headaches and at the current time only 50 percent of these patients respond to these migraine specific medications like Imitrex and the others. These patients, as I mentioned, may resort to narcotics or analgesics and they get dependent to these medications. So you have a significant proportion, which is more than 50 percent, that these medications are not effective so TMS is an alternative to them.
Were you pleased with the results of the study?
Dr. Mohammad: Yes, we were very pleased. This is consistent with the study results that we did a few years ago. We were very pleased and excited.
You kind of touched on this, but why is it good to have an option that is not a medication?
Dr. Mohammad: As I mentioned the device was effective. It was also safe and painless. All the current migraine specific medications have potential adverse reactions. Moreover, these medications are contraindicated in few patients because of the co-morbid conditions. In addition to this, the frequent intake of analgesic and narcotics leads to dependency and rebound effect. Hence, TMS will be a great option/alternative to many migraine victims.
How remarkable or medically advanced is it something like that can disrupt a migraine?
Dr. Mohammad: It is very unique. I would like to use this analogy on how the device or magnetic pulses works. For example, consider if you have a fire that starts in a forest and then spreads from one tree to another until it reaches the house and burns it. Now, if you cut few trees in the middle, then the fire won't spread and reach the house. This is exactly what we are doing with these magnetic pulses. We are interrupting this electrical storm or current, in the brain, before it leads to the headache.
