Repetitive transcranial magnetic stimulation versus botulinum toxin injection in chronic migraine prophylaxis: a pilot randomized trial

Abstract

BackgroundChronic migraine is a prevalent disabling disease, with major health-related burden and poor quality of life. Long-term use of preventive medications carries risk of side effects.ObjectivesThe aim of this study was to compare repetitive transcranial magnetic stimulation (rTMS) to botulinum toxin-A (BTX-A) injection as preventive therapies for chronic migraine.MethodsA pilot, randomized study was conducted on a small-scale sample of 29 Egyptian patients with chronic migraine, recruited from Kasr Al-Aini teaching hospital outpatient clinic and diagnosed according to ICHD-III (beta version). Patients were randomly assigned into two groups; 15 patients received BTX-A injection following the Phase III Research Evaluating Migraine Prophylaxis Therapy injection paradigm and 14 patients were subjected to 12 rTMS sessions delivered at high frequency (10 Hz) over the left motor cortex (MC, M1). All the patients were requested to have their 1-month headache calendar, and they were subjected to a baseline 25-item (beta version) Henry Ford Hospital Headache Disability Inventory (HDI), Headache Impact Test (HIT-6), and visual analogue scale assessment of headache intensity. The primary efficacy measures were headache frequency and severity; secondary measures were 25-item HDI, HIT-6, and number of acute medications. Follow-up visits were scheduled at weeks 4, 6, 8, 10, and 12 after baseline visit.ResultsA reduction in all outcome measures was achieved in both the groups. However, this improvement was more sustained in the BTX-A group, and both the therapies were well tolerated.ConclusionBTX-A injection and rTMS have favorable efficacy and safety profiles in chronic migraineurs. rTMS is of comparable efficacy to BTX-A injection in chronic migraine therapy, but with less sustained effect.

Transcranial Magnetic and Direct Current Stimulation (TMS/tDCS) for the Treatment of Headache: A Systematic Review

“…There were a total of 34 studies included in the descriptive synthesis. Of those, 22 were TMS (16 rTMS) and 12 were tDCS articles (Supplementary Materials – Study Characteristics Tables). A comparison of defining study parameters is outlined below.…”

“…Twelve TMS studies (9 rTMS, 2 sTMS, and 1 dTMS) were randomized trials. The remaining 10 were either non‐randomized controlled or prospective cohort/open label trials .…”

“…Three were graded as high quality with a low overall risk of bias . Five studies were moderate (uncertain risk of bias), 6 low (high risk of bias), and 2 very low quality (high/uncertain risk of bias) …”

“…for full details and exclusion reasons.Study Characteristics.-There were a total of 34 studies included in the descriptive synthesis. Of those, 22 were TMS (16 rTMS [52][53][54][55][56][57][58][59][60][61][62][63][64][65][66]72 ) and 12 were tDCS10,[38][39][40][41][42][43][44][45][46][47]74 articles (Supplementary Materials 2 -Study Characteristics Tables). A comparison of defining study parameters is outlined below.…”

Effects of Non‐invasive Brain Stimulation on Headache Intensity and Frequency of Headache Attacks in Patients With Migraine: A Systematic Review and Meta‐Analysis

“…The 2 studies were not included in our meta-analysis because they did not report enough data for the estimation of effect sizes. 34,35 Inhibitory rTMS via a circular coil to the vertex -which is assumed to suppress the excitability of bilateral motor corticeswas not superior to sham stimulation in the reduction of headache intensity and frequency of headache attack, according to one study 24 included in our analysis. Motor cortex excitability in patients with migraine is still controversial, with some studies reporting hyperactive interictal cortical excitability of motor cortex, whereas others find hypoactive cortical excitability instead.…”