Faculty of 1000

Post-publication peer review

Migraines, magnets and a vocabulary straight from science fiction

Posted by Callum Anderson on 30 March, 2010

Whenever Richard Lipton releases a new migraine study I always receive it with interest. Partly because his work is pretty cutting edge and and he leads an excellent team, but partly because migraine science can sometimes sound like an encounter of the third kind in a science fiction novel.

Migraines are typically defined as one sided, throbbing headaches, typically accompanied by other symptoms, ranging from a non-specific ‘aura’ to zigzagging or flashing lights, a specific smell, nausea or sensitivity to light or sound.

According to some research , migraines affect close to 12% of the world’s population.

Well, Professor Lipton and his team at Albert Einstein College of Medicine have certainly not let us science fiction fans down this time either, publishing a randomised, double-blind, parallel-group, sham-controlled trial in which a hand-held transcranial magnetic stimulation device is used to treat the migraine.

Image by Andy Field (Hubmedia) via Flickr

Image by Andy Field (Hubmedia) via Flickr

The interesting thing about this study is that it tests a “handheld device” capable of alleviating migraine aura. So in theory, the study could lead to development of a product that allows sufferers to treat themselves at home rather than rely on a clinician. This is especially useful for something like a migraine which tends todevelop and subside rapidly.

The study randomized participants by computer, handing approximately half (99) a sham stimulation and the others (102) were given the sTMS device.
Those who used the real device had less pain and recurring headaches and were less likely to need medication. Of 164 patients who treated at least one attack with the real or fake stimulation devices, 39 percent of those who used the real device reported no pain after two hours compared to 22 percent of those who used the fake device.

Here are the results

37 patients did not treat a migraine attack and were excluded from outcome analyses. 164 patients treated at least one attack with sTMS (n=82) or sham stimulation (n=82; modified intention-to-treat analysis set). Pain-free response rates after 2 h were significantly higher with sTMS (32/82 [39%]) than with sham stimulation (18/82 [22%]), for a therapeutic gain of 17% (95% CI 3-31%; p=0.0179). Sustained pain-free response rates significantly favoured sTMS at 24 h and 48 h post-treatment. Non-inferiority was shown for nausea, photophobia, and phonophobia. No device-related serious adverse events were recorded, and incidence and severity of adverse events were similar between sTMS and sham groups.

When (and even if) this treatment comes onto the market, it remains unclear, how much it will cost, and Neuralieve don’t have any pricing details on their website.

I am tentatively guessing that a technology in infancy like this won’t be particularly affordable for a good few years, but with more trials comes more corporate interest and it is important to consider that the potential market for something like this could be as high as the aforementioned 12% of population, which globally, represents a huge number.

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