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

Nov 27, 2023

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

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 ( = 0.089; = 0.081, = 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 ( = 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.

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ABOUT THE EXPERTS

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

Corinna Börner-Schröder

Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany.

TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany.

Magdalena Lang

Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

Giada Urban

Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

Erik Zaidenstadt

Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

Jacob Staisch

Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

Ari Hauser

Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

Iris Hannibal

Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

Kristina Huß

LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

Birgit Klose

Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

Matthias F Lechner

Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

Nico Sollmann

Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany.

TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany.

Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany.

Mirjam N Landgraf

Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

Florian Heinen

Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

Michaela V Bonfert

Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany.

LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany.