• Emily Stephens, Chathurika S Dhanasekara, Victor Montalvan, Bei Zhang, Ashley Bassett, Rebecca Hall, Alyssa Rodaniche, Christina Robohm-Leavitt, Chwan-Li Shen, and Chanaka N Kahatuduwa.
• School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
• Curr Pain Headache Rep. 2024 Apr 1; 28 (4): 149167149-167.

Purpose Of ReviewManagement of chronic daily headaches (CDH) remains challenging due to the limited efficacy of standard prophylactic pharmacological measures. Several studies have reported that repetitive transcranial magnetic stimulation (rTMS) can effectively treat chronic headaches. The objective was to determine the utility of rTMS for immediate post-treatment and sustained CDH prophylaxis.Recent FindingsAll procedures were conducted per PRISMA guidelines. PubMed, Scopus, Web of Science, and ProQuest databases were searched for controlled clinical trials that have tested the efficacy of rTMS on populations with CDH. DerSimonian-Laird random-effects meta-analyses were performed using the 'meta' package in R to examine the post- vs. pre-rTMS changes in standardized headache intensity and frequency compared to sham-control conditions. Thirteen trials were included with a combined study population of N = 538 patients with CDH (rTMS, N = 284; Sham, N = 254). Patients exposed to rTMS had significantly reduced standardized CDH intensity and frequency in the immediate post-treatment period (Hedges' g = -1.16 [-1.89, -0.43], p = 0.002 and Δ = -5.07 [-10.05, -0.11], p = 0.045 respectively). However, these effects were sustained marginally in the follow-up period (Hedges' g = -0.43 [-0.76, -0.09], p = 0.012 and Δ = -3.33 [-5.52, -1.14], p = 0.003). Significant between-study heterogeneity was observed, at least partially driven by variations in rTMS protocols. Despite the observed clinically meaningful and statistically significant benefits in the immediate post-treatment period, the prophylactic effects of rTMS on CDH do not seem to sustain with discontinuation. Thus, the cost-effectiveness of the routine use of rTMS for CDH prophylaxis remains questionable.RegistrationProtocol preregistered in PROSPERO International Prospective Register of Systematic Reviews (CRD42021250100).© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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