Serial Changes in Diffusion Tensor Imaging Metrics and Therapeutic Effects of Repetitive Transcranial Magnetic Stimulation in Post-traumatic Headache and Depression: A Case Report

Abstract

Abstract Background: Post-traumatic headache is a common symptom of mild traumatic brain injury (mTBI). This case study reports the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) in mTBI patient with headache and depression through objective serial changes of diffusion tensor imaging (DTI). Case presentation: The 51-year-old man complained of a headache despite conventional treatment for 13 months. We applied 15 times rTMS on the left dorsolateral prefrontal cortex. We checked the pain and depression through numeric rating scale (NRS) and Beck depression inventory (BDI) when admission, discharged, and 1 month after discharge. DTI was performed 3 times; before, during-day of rTMS 6th stimulation, and after-day of rTMS 15th stimulation. Then the reconstructed white matter related to pain and depression was obtained. NRS and BDI showed significant improvement and it was maintained one year after discharge. DTI-based metrics of the white matters related to pain and depression gradually increased before - during - after rTMS. Conclusions: Studies focused on examining changes in pain, depression and DTI-based metrics of white matter are rare. This case is significant in that not only pain and depression improved after the rTMS, but also serial changes in white matter were observed in DTI.