High-rate repetitive transcranial magnetic stimulation in migraine prophylaxis: a randomized, placebo-controlled study

Abstract

Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for pain but there is no class 1 study on its role in migraine prophylaxis. In this study we report the efficacy and safety of high-rate rTMS in migraine prophylaxis. Adult migraine patients having >4 attacks/month were randomized to high-rate rTMS or sham stimulation. Stimulation in the form of 10 Hz rTMS, 600 pulses in 10 trains were delivered to the hot spot of the right abductor digiti minimi in 412 s. Three sessions were delivered on alternate days. The outcome was defined at 1 month. The primary outcome measures were reduction in headache frequency and severity >50 % as assessed by the Visual Analogue Scale (VAS). The secondary outcome measures were functional disability, rescue medication and adverse events. Fifty patients each were randomized to rTMS or sham stimulation. The baseline characteristics of rTMS and sham stimulation groups were similar. At 1 month, headache frequency (78.7 vs. 33.3 %; P = 0.0001) and VAS score (76.6 vs. 27.1 %; P = 0.0001) improved significantly in the patients receiving rTMS compared to those in the sham stimulation group. Functional disability also improved significantly in rTMS group (P = 0.0001). Only one patient following rTMS developed transient drowsiness and was withdrawn from the study. This study provides evidence of the efficacy and safety of 10 Hz rTMS in migraine prophylaxis.

New and Emerging Treatments for Migraine

“…Teepker et al showed a reduction of headache frequency in a study of low-frequency rTMS in 27 patients, but the difference was not significant compared to the sham-treated group [30]. In a randomised, double-blind, palcebo-controlled trial, 50 adult migraineurs having more than 4 attacks in a month were assigned to either high-frequency rTMS or sham treatment [31]. At 1 month, the rTMS-treated group showed a reduction in headache frequency in 78.7% compared to 33.3% in those receiving sham.…”

Repetitive transcranial magnetic stimulation in neurology and psychiatry

“…Работы, посвященные использованию рТМС в лечении мигрени, немногочисленны [98][99][100][101][102][103][104][105][106]. В слепом рандомизированном плацебо-контролируемом исследовании эффективности рТМС зоны М1 левого по-лушария в лечении мигрени [105] было показано досто-верное уменьшение частоты мигренозных приступов, ин-тенсивности болей, степени инвалидизации пациентов. Клиническое улучшение связывалось с повышением уровня β-эндорфина в плазме крови.…”

Effect of high rate rTMS on somatosensory evoked potential in migraine

“…The study was approved by Institute Ethics Committee (PGI/ BE/256/2011). This is a sub analysis of our earlier study, in which we reported high rate rTMS as a migraine prophylaxis (16).…”

“…It produced a similar sound, but did not produce muscle contraction. The motor threshold, however, was not measured for sham stimulation to avoid the effect of true stimulation (16).…”

“…A single pulse of transcranial magnetic stimulation (TMS) has been reported to relieve pain at 2 hours in 81% patients in an open labeled study, and 39% to 69% in randomized control trials (14,15). High rate repetitive TMS (rTMS) at 10 Hz, 600 pulses delivered to the hotspot of the right abductor digit minimi for three days was effective in reducing the severity of pain in 78.7% and frequency in 76.6% of patients (16). The basis of clinical response following rTMS has been evaluated in only a few studies (17,18).…”