sTMS for Chronic Migraine, 55 yr old female

A 55-year-old female patient with chronic migraine presented for evaluation and treatment at a neurological center in England. The patient reported that her symptoms had begun at age of 12. There was no known family history of migraines but she had suffered a significant concussion at 10, two years prior to migraine onset. During the past 15 years, she had experienced an increase in migraine severity, currently averaging 22 migraines per month. The patient stated that she had tried multiple therapeutic regimens aimed at reducing migraines: preventative medications, rescue medications (including triptans), aromatherapy, acupuncture, mouth guard, and occipital nerve blocks. In addition, she instituted such life style adjustments as bedtime routine, Pilates classes, and dietary changes leading to a weight loss of 75 Ibs. Each of these approaches provided limited and temporary relief. Continuous use of topriamate caused the patient to experience suicidal ideation, leading her to seek other approaches. Through social media and her Headache Specialist General Practitioner, she learned about sTMS therapy. Her GP subsequently referred her to a neurologist specializing in headache. At the conclusion of the intake interview, her neurologist prescribed sTMS.