Repetitive transcranial magnetic stimulation in the treatment of tension-type headache in children and adolescents: an open-label prospective clinical study

INTRODUCTION. The article presents the results of a clinical study of the efficacy and safety of repetitive transcranial magnetic stimulation in children with frequent episodic and chronic tension headache (CTH). AIM. To study the efficacy and safety of repetitive transcranial magnetic stimulation in children and adolescents with frequent episodic and chronic tension-type headache (TTH). MATERIALS AND METHODS. A prospective open cohort clinical study of pediatric patients with a diagnosis of frequent episodic and chronic TTH was conducted at Children’s City Polyclinic No. 39 in Moscow from December 2024 to November 2025. The study included 79 patients aged 8–17 years (mean age 13.36 ± 2.55 years) were included. The method of repetitive magnetic stimulation of the left dorsolateral prefrontal cortex was used with a power of 70–90 % of the individual threshold value of the evoked motor response, a frequency of 10 Hz in intermittent mode (4 sec of stimulation, 11 sec of pausing), with a total procedure duration of 16–19 minutes (2500–3000 pulses in total). Therapy efficacy was evaluated by analyzing the changes in headache diary parameters, diagnostic questionnaires, and instrumental research data. RESULTS. During treatment, there was a significant positive trend in the main criterion of effectiveness — the frequency of episodes and intensity of headache (p 0.001 and p 0.001 respectively), persisting in the delayed period. When assessing the emotional state on the HADS (Hospital Anxiety and Depression Scale) scale after the rTMS course, the proportion of respondents was 50 % in terms of the dynamics of anxiety and depression symptoms (p 0.001, McNemar criterion). There was a significant positive trend on the Spielberger-Khanin scale of situational and personal anxiety (p 0.001 for all parameters) and the CPAQ-R chronic pain acceptance questionnaires (p 0.001) and PedsQL quality of life questionnaire (p 0.001). DISCUSSION. The emotional background in CTH is mainly accompanied by an increase in the level of personal and reactive anxiety. A cumulative analysis of the conducted instrumental physiological tests shows that transcranial neurostimulation techniques can enhance the functionality of the nervous system. However, in order to confirm this observation, a longer delayed assessment period and an increased sample size in each age category are necessary. The effect obtained is directly related to the effect of rTMS and the features of the protocol used. The effect of dorsolateral prefrontal cortex stimulation on the emotional state of patients with anxiety and depressive disorders can be attributed to the neuromodulating effect of repetitive transcranial magnetic stimulation (rTMS). CONCLUSION. Transcranial magnetic stimulation of the left dorsolateral prefrontal cortex significantly reduces both the number of headache episodes and its intensity, while the effect persists or increases after the end of the course of procedures, and reduces symptoms of anxiety and depression in children. The assessment of the safety and tolerability of the procedures revealed isolated cases of adverse events (no more than 5 % of the total sample of patients), which indicates the possibility of using the rTMS protocol with subthreshold intensity in the age range of 8–17 years.