sTMS for Chronic Migraine with Aura, 69 yr old female

A 69-year-old female with symptoms of migraine presented for evaluation at a neurological center. The patient reported that her migraine symptoms had begun during childhood, then worsened with age until finally peaking in severity at peri-menopause (45 years). Her early medication regimens provided no relief until the availability of triptans. When using triptans, she experienced temporary relief from headache until the efficacy would inexplicably cease. Patient reported that rescue medication were “effective” but led to rebound headaches. Non-medication remedies either worked temporarily or not at all. Several years before presenting for evaluation, she had attended a 10-day inpatient pain program, where she received both medications (preventative and rescue) and lifestyle education. Not unlike the triptans, the helpful effects were temporary. At present, she experiences both prodromal and after-effects of severe fatigue and confusion; classic visual auras precede some headaches. After evaluation and examination, the neurologist confirmed the diagnosis of chronic migraine.