Effectiveness of High-Frequency Repetitive Transcranial Magnetic Stimulation in Migraine

Abstract

The aim of the study was to evaluate the effectiveness of repetitive transcranial magnetic stimulation in migraine measured by decrease in pain severity or attack frequency. Methods: A search at the Cochrane Controlled Trials Register (CEN-TRAL), MEDLINE (via PubMed), Embase, CINAHL, Web of Science, and Scopus. The risk of systematic bias was rated by using the Cochrane domain-based quality assessment tool. A randomeffects model was used. Results: Of 434 identified records, 8 randomized control studies were included in the meta-synthesis. All have used a high-frequency repetitive transcranial magnetic stimulation targeting the left dorsolateral prefrontal cortex. The risk of systematic bias was low. The difference between repetitive transcranial magnetic stimulation and control groups in frequency of migraine days per month was 8.1 (95% confidence interval = 4.8-11.4) days in favor of repetitive transcranial magnetic stimulation. Respectively, for intensity of migraine pain (scaled from 0 to 100), this difference was 13.6 (95% confidence interval = 5.3-21.8) points in favor of repetitive transcranial magnetic stimulation. The heterogeneity was substantial with I 2 = 86%. Conclusions: In chronic migraine, repetitive transcranial magnetic stimulation seems to have positive effects on both migraine pain severity and attack frequency compared with sham stimulation. Although the effect on pain intensity was probably clinically insignificant, repetitive transcranial magnetic stimulation reduced pain frequency by 8 days per month on average.

Transcranial Magnetic Stimulation as a Therapy for Migraine: An Overview of Systematic Reviews

“…Finally, 7 studies were considered as meeting our inclusion criteria. [18][19][20][21][22][23][24] A flow chart of literature selection is shown in Figure 1.…”

“…Table 3 displays the results of evaluating methodological quality using the AMSTAR 2 tool. Among the 7 SRs, 4 were rated as moderate quality 19,[21][22][23] and 3 were rated as low quality 18,20,24 It was worth noting that items 2 and 7 received poor ratings. All the SRs included PICO components and 4 19,[21][22][23] reported study protocols in advance.…”

“…Among the 7 SRs, 4 were rated as moderate quality 19,[21][22][23] and 3 were rated as low quality 18,20,24 It was worth noting that items 2 and 7 received poor ratings. All the SRs included PICO components and 4 19,[21][22][23] reported study protocols in advance. However, none of them provided a comprehensive list of excluded studies with exclusion reasons.…”

“…Several SRs and MAs have been conducted to assess the effectiveness and safety of TMS for migraine management. [18][19][20][21][22][23][24] However, not all SRs can provide reliable evidence, and low-quality evidence can mislead clinical decision-making. Therefore, an overview that summarizes the current evidence on the efficacy and safety of TMS for migraine treatment is needed.…”

Repetitive Transcranial Magnetic Stimulation for Neuropathic Pain and Neuropsychiatric Symptoms in Traumatic Brain Injury: A Systematic Review and Meta-Analysis

“…In addition, rTMS has been recommended by the International Federation of Clinical Neurophysiology for the management of neurological and psychiatric disorders [26], and evidence is now quickly increasing, highlighting that DLPFC-rTMS should relieve pain in patients with chronic pain conditions, including migraine [27], spinal cord injury [26], and fibromyalgia syndrome [28]. Actually, a recent meta-analysis found that high-frequency DLPFC stimulation is able to induce an analgesic effect in patients with chronic pain [29], but at present, the overwhelming majority of systematic reviews and meta-analyses on health-related consequences after TBI have focused on depression, memory, selective attention, and postconcussion syndrome [30][31][32], with far less attention given to neuropathic pain.…”