The role of left prefrontal transcranial magnetic stimulation in episodic migraine prophylaxis

Abstract

Objective: The aim of the study was to examine the prophylactic role of repetitive transcranial magnetic stimulation (rTMS) on the frequency, and severity of migraine attacks in episodic migraineurs who failed medical treatment. Methods: A randomized double-blinded placebo-controlled study was designed to assess the effect of 5 Hz rTMS applied over the left dorsolateral prefrontal cortex (LDLPFC ) in 33 migraineurs. Patients were followed up for 1 month before receiving rTMS, and for another month after the sessions by a headache diary. The primary outcome measure was the achievement of 50% reduction in the number of migraine attacks. Secondary outcome measures included migraine days, assessment of migraine attack severity, disability by HIT-6, and side-effects to the procedure.Results: The study revealed that 69.2% of the active treatment group achieved 50% or more reduction in the number of migraine attacks versus 25% of cases in the control group (p = 0.02). The absolute number of migraine attacks was reduced by 3.1 vs 1.5 in the active and control group, respectively. The number of cases with severe HIT-6 scores was reduced by 46.2% in active treatment group versus a 7.1% reduction in the control group (p = 0.02). Conclusion: High-frequency rTMS applied to LDLPFC can reduce the number of migraine attacks by 50% or more in almost 70% of a sample of episodic migraineurs with a concomitant decrease in functional disability.

Non-Invasive Neurostimulation Methods for Acute and Preventive Migraine Treatment—A Narrative Review

“…Two other recent studies with stimulation of the left DLPFC were positive in the primary outcome, using a frequency of 5 Hz in one case [ 41 ] and intermittent theta-burst stimulation in the other [ 42 ]. However, the first study was negative for the reduction in headache days.…”

Repetitive Transcranial Magnetic Stimulation for Neuropathic Pain on the Non-Motor Cortex: An Evidence Mapping of Systematic Reviews

“…ese targets are also importantly involved in nociceptive modulation; they share some common mechanisms, such as the involvement in altering human temperature pain thresholds [50], inducing striatal dopamine release that modulates pain [51], and causing cerebral hemodynamic changes in broader cortical regions (e.g., cingulate cortex, anterior frontal cortex, thalamus, and other subcortical areas involved in pain modulation) [52]. Another important finding was that most studies tend to suggest that high-frequencies produce better effects [49,[53][54][55][56][57][58][59][60][61]. is may be due to the factor that high-frequency rTMS can directly excite the injured hemisphere, thus directly improving pain.…”

High-frequency repetitive transcranial magnetic stimulation at dorsolateral prefrontal cortex for migraine prevention: A systematic review and meta-analysis

“…The included studies comprised research from four nations. Specifically, two were conducted in Italy (32,33), one originated in Brazil (34), one was conducted in Bulgaria (27), and one was from Egypt (20). Four studies consisted of research trials into chronic migraines (27,(32)(33)(34).…”

“…Four studies consisted of research trials into chronic migraines (27,(32)(33)(34). Only one study involved episodic migraines (20). Headache days, pain intensity, medication intake, and functional disabilities were adopted as outcome measurements in 80% of studies, whereas headache frequency was recorded in just 40% of the studies.…”

“…Furthermore, rTMS may be able to modulate thalamocortical signals (18) and normalise brain excitability in migraine patients (19). Randomised controlled trials in clinical contexts have demonstrated that HF-rTMS reduces migraine attack frequency and pain intensity, in addition to improving the functional disability of migraine patients when compared to placebos (20)(21)(22)(23).…”