rTMS Treatment of Persistent Headache and Post Concussion Symptoms Attributed to Mild Traumatic Injury to the Head
rTMS Treatment of Persistent Headache and Post Concussion Symptoms Attributed to Mild Traumatic Injury to the Head
The objective of this study is to investigate the treatment effect of repetitive transcranial
 magnetic stimulation in patients with a history of both persistent post-traumatic headache
 and post-concussion symptoms. In this double-blind, sham-controlled, concealed allocation,
 randomized clinical trial, 20 patients aged 18-65 yrs will be recruited from the Calgary
 Brain Injury Program (CBIP) and the Calgary Headache Assessment and Management Program
 (CHAMP) / Calgary Chronic Pain Centre, Calgary, Alberta, Canada. Patients will engage in a
 two-week rTMS treatment protocol (10 treatments) and will be followed for 6 months after
 therapy.
Demographic information will be collected two weeks prior to starting the study including
 age, sex, education, headache history, concussion history, past medical history, medication
 use, and family medical history. Headache history will be collected including frequency,
 severity, medication-use, type of headache, associated symptoms (i.e. neck pain, photophobia,
 phonophobia, nausea, vomiting) and headache triggers. Baseline questionnaires will be
 completed including headache intensity scale - 6 (HIT-6), Rivermead PPCS questionnaire,
 British Columbia post-concussion symptom inventory (BC-PSI), Montreal cognitive assessment
 (MoCA), quality of life after brain injury questionnaire (QOLIBRI), patient health
 questionnaire-9 (PHQ-9), generalized anxiety disorder scale-7 (GADS-7) and the post traumatic
 stress disorder checklist for DSM-5 (PCL-5). Patients will keep a two-week baseline headache
 diary before treatment, 2 weeks during treatment, 2 weeks following rTMS, and for 2 weeks at
 the 1, 3, and 6 month follow up assessments (total of 12 weeks). Patients will be reassessed
 at the completion of their rTMS treatment (day 14), and at 1, 3, and 6 months post-treatment.
 The questionnaires including: HIT-6, Rivermead PPCS questionnaire, PC-PSI, QOLIBRI, PHQ-9 and
 GAD-7 will be completed at all follow up visits.
Inclusion Criteria:

 -  Diagnosis of a persistent headache attributed to traumatic injury to the head based on
 the ICHD-3 criteria

 -  Diagnosis of persistent post-concussion symptoms based on the ICD-10 criteria

 -  mTBI occurrence from 3 months to 5 years from study start date

 Exclusion Criteria:

 -  Prior history of TMS therapy

 -  TMS-related contraindications (pacemaker, metallic implant)

 -  History of chronic headache (>15 days/month for 3 months) or migraine prior to most
 recent trauma

 -  Other medical conditions such as: structural brain disease, previous seizure,
 psychotic disorders (schizophrenia, bipolar disorder), liver or kidney disease,
 malignancy, uncontrolled hypertension or diabetes, and pregnancy