sTMS / Relivion

Summary:
Single-pulse transcranial magnetic stimulation (sTMS) and Relivion are non-invasive brain stimulation devices that use magnetic fields to modulate cortical excitability. They are approved for acute and preventive migraine treatment.

Biological Plausibility

TMS suppresses cortical spreading depression, a key event in migraine with aura. It may also reset dysfunctional thalamo-cortical rhythms that contribute to chronic migraine.

Evidence

RCTs show sTMS is effective in treating migraine with aura and may reduce frequency when used daily. Preventive benefit is more variable and may depend on adherence.

Effect Size

Average reduction of 1–2 migraine days/month preventively. For acute treatment, about 40% achieve pain relief at 2 hours post-stimulation.

⚠️ Risk

Low. Some users experience scalp discomfort or transient dizziness. Serious adverse events are rare.

Cost

$$$

Scores

  • Benefit: 2
  • Burden: 4
  • Ratio: 0.5

Clinical Takeaways

  • Particularly helpful for patients with migraine with aura.
  • Requires daily use or early intervention for best results.
  • Cost and logistics (prescription, training) may be barriers.

Key References

  • Lipton RB, et al. *Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: a randomized, double-blind, sham-controlled trial.* Lancet Neurol. 2010.
  • Starling AJ, et al. *Non-invasive neuromodulation for migraine and cluster headache: a systematic review and meta-analysis.* Cephalalgia. 2021.
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