Skip to main content
NCBI home page
Neurotherapeutics logoLink to Neurotherapeutics
. 2010 Apr;7(2):204–212. doi: 10.1016/j.nurt.2010.03.002

Transcranial magnetic simulation in the treatment of migraine

Richard B Lipton 1,2,3,✉, Starr H Pearlman 4
PMCID: PMC5084102  PMID: 20430320

Summary

Transcranial magnetic stimulation (TMS) is a diagnostic and therapeutic modality that is being developed as both an acute and preventive treatment for migraine. TMS delivers a fluctuating magnetic field from the scalp surface to induce current in the subjacent cortex. Magnetic pulses are delivered one at a time in single-pulse TMS (sTMS) or as a train of pulses in repetitive TMS (rTMS). For most of its 30-year history, TMS has been delivered in clinical and research settings using large tabletop devices. Based on the theory that sTMS may disrupt cortical spreading depression, sTMS has been studied and shown to be effective as an acute treatment for migraine with aura. Subsequent work in animal models confirms that sTMS disrupts cortical spreading depression. To make outpatient self-treatment possible, a portable device has been developed for acute treatment of migraine with aura. Based on the theory that rTMS alters brain excitability and neurotransmitter activity, rTMS has been studied as a preventive migraine treatment. A small body of evidence suggests that rTMS may have a role, but further studies are needed. In this review, we summarize the data on TMS as a treatment of migraine, and we suggest directions for future research.

Key Words: Migraine, acute treatment, cortical spreading depression, transcranial magnetic stimulation

References

  • 1.Rossi S, Hallett M, Rossini PM, Pascual-Leone A, Safety of TMS Consensus Group Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009;120:2008–2039. doi: 10.1016/j.clinph.2009.08.016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Aurora SK, Welch KM, Al-Sayed F. The threshold for phosphenes is lower in migraine. Cephalalgia. 2003;23:258–263. doi: 10.1046/j.1468-2982.2003.00471.x. [DOI] [PubMed] [Google Scholar]
  • 3.Couturier JL. Efficacy of rapid-rate repetitive transcranial magnetic stimulation the treatment of depression: a symptomatic review and meta-analysis. J Psychiat Neurosci. 2005;30:83–90. [PMC free article] [PubMed] [Google Scholar]
  • 4.Gershon AA, Dannon PN, Granhaus L. Transcranial magnetic stimulation in the treatment of depression. Am J Psychiat. 2003;160:835–845. doi: 10.1176/appi.ajp.160.5.835. [DOI] [PubMed] [Google Scholar]
  • 5.Avery DH, Holtzheimer PE, Fawaz W, et al. A controlled study of repetitive transcranial magnetic stimulation in medication-resistant major depression. Biol Psychiatry. 2006;59:187–194. doi: 10.1016/j.biopsych.2005.07.003. [DOI] [PubMed] [Google Scholar]
  • 6.Pascual-Leone A, Rubio B, Pallardó F, Catalá MD. Rapid-rate transcranial magnetic Stimulation of left dorsolateral prefrontal cortex in drug-resistant depression. Lancet. 1996;348:233–237. doi: 10.1016/S0140-6736(96)01219-6. [DOI] [PubMed] [Google Scholar]
  • 7.Praharaj SK, Ram D, Arora M. Efficacy of high frequency (rapid) suprathreshold repetitive transcranial magnetic stimulation of right prefrontal cortex in bipolar mania: a randomized sham controlled study. J Affect Disord. 2009;117:146–150. doi: 10.1016/j.jad.2008.12.020. [DOI] [PubMed] [Google Scholar]
  • 8.Kaptsan A, Yaroslavsky Y, Applebaum J, Belmaker RH, Grisaru N. Right prefrontal TMS versus sham treatment of mania: a controlled study. Bipolar Disord. 2003;5:36–39. doi: 10.1034/j.1399-5618.2003.00003.x. [DOI] [PubMed] [Google Scholar]
  • 9.Nahas Z, Kozel FA, Li X, Anderson B, George MS. Left prefrontal transcranial magnetic stimulation (TMS) treatment of depression in bipolar affective disorder: a pilot study of acute safety and efficacy. Bipolar Disord. 2003;5:40–47. doi: 10.1034/j.1399-5618.2003.00011.x. [DOI] [PubMed] [Google Scholar]
  • 10.Fregni F, Simon DK, Wu A, Pascual-Leone A. Non-invasive brain stimulation in neurology-perspectives on the therapeutic potential of rTMS and tDCS. Nat Clin Pract Neurol. 2007;3:383–393. doi: 10.1038/ncpneuro0530. [DOI] [PubMed] [Google Scholar]
  • 11.Prasko J, Zálesky R, Bares M, et al. The effect of repetitive transcranial magnetic stimulation (rTMS) add on serotonin re-uptake inhibitors in patients with panic disorder: a randomized, double blind sham controlled study. Neuro Endocrinol Lett. 2007;28:33–38. [PubMed] [Google Scholar]
  • 12.Matheson SL, Green MJ, Loo C, Carr VJ. Quality assessment and comparison of evidence for electroconvulsive therapy and repetitive transcranial magnetic stimulation for schizophrenia: a systematic meta-review. Schizophr Res 2010 Jan 29; [Epub ahead of print]. [DOI] [PubMed]
  • 13.Hoffman RE, Gueorguieva R, Hawkins KA, et al. Temporoparietal transcranial magnetic stimulation for auditory hallucinations: safety, efficacy and moderators in a fifty patient sample. Biol Psychiatry. 2005;58:97–104. doi: 10.1016/j.biopsych.2005.03.041. [DOI] [PubMed] [Google Scholar]
  • 14.Cohen H, Kaplan Z, Kotler M, Kouperman I, Moisa R, Grisaru N. Repetitive transcranial magnetic stimulation of the right dorsolateral prefrontal cortex in posttraumatic stress disorder: a double-blind, placebo-controlled study. Am J Psychiatry. 2004;161:515–524. doi: 10.1176/appi.ajp.161.3.515. [DOI] [PubMed] [Google Scholar]
  • 15.Camprodon JA, Martínez-Raga J, Alonso-Alonso M, Shih MC. Pascual-Leone A. One session of high frequency repetitive transcranial magnetic stimulation (rTMS) to the right prefrontal cortex transiently reduces cocaine craving. Drug Alcohol Depend. 2007;86:91–94. doi: 10.1016/j.drugalcdep.2006.06.002. [DOI] [PubMed] [Google Scholar]
  • 16.Lefaucheur JP, Drouot X, Von Raison F, Ménard-Lefaucheur I, Cesaro P, Nguyen JP. Improvement of motor performance and modulation of cortical excitability by repetitive transcranial magnetic stimulation of the motor cortex in Parkinson’s disease. Clin Neurophysiol. 2004;115:2530–2541. doi: 10.1016/j.clinph.2004.05.025. [DOI] [PubMed] [Google Scholar]
  • 17.Elahi B, Elahi B, Chen R. Effect of transcranial magnetic stimulation on Parkinson motor function—systematic review of controlled clinical trials. Mov Disord. 2009;24:357–363. doi: 10.1002/mds.22364. [DOI] [PubMed] [Google Scholar]
  • 18.Tergau F, Wassermann EM, Paulus W, Ziemann U. Lack of clinical improvement in patients with Parkinson’s disease after low and high frequency repetitive transcranial magnetic stimulation. Electroencephalogr Clin Neurophysiol Suppl. 1999;51:281–288. [PubMed] [Google Scholar]
  • 19.Borich M, Arora S, Kimberley TJ. Lasting effects of repeated rTMS application in focal hand dystonia. Restor Neurol Neurosci. 2009;27:55–65. doi: 10.3233/RNN-2009-0461. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.De Ridder D, De Mulder G, Menovsky T, Sunaert S, Kovacs S. Electrical stimulation of auditory and somatosensory cortices for treatment of tinnitus and pain. Prog Brain Res. 2007;166:377–388. doi: 10.1016/S0079-6123(07)66036-1. [DOI] [PubMed] [Google Scholar]
  • 21.Tassinari CA, Cincotta M, Zaccara G, Michelucci R. Trancranial magnetic stimulation and epilepsy. Clin Neurophiol. 2003;114:777–798. doi: 10.1016/S1388-2457(03)00004-X. [DOI] [PubMed] [Google Scholar]
  • 22.Santiago-Rodríguez E, Cárdenas-Morales L, Harmony T, Fernández-Bouzas A, Porras-Kattz E, Hernández A. Repetitive transcranial magnetic stimulation decreases the number of seizures in patients with focal neocortical epilepsy. Scizure. 2008;17:677–683. doi: 10.1016/j.seizure.2008.04.005. [DOI] [PubMed] [Google Scholar]
  • 23.Takeuchi N, Tada T, Toshima M, Matsuo Y, Ikoma K. Repetitive transcranial magnetic stimulation over bilateral hemispheres enhances motor function and training effect of paretic hand in patients after stroke. J Rehabil Med. 2009;41:1049–1054. doi: 10.2340/16501977-0454. [DOI] [PubMed] [Google Scholar]
  • 24.Lefaucheur JP, Drouot X, Ménard-Lefaucheur I, Keravel Y, Nguyen JP. Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain. Neurology. 2006;67:1568–1574. doi: 10.1212/01.wnl.0000242731.10074.3c. [DOI] [PubMed] [Google Scholar]
  • 25.Lipton RB, Dodick DW, Silberstein SD, et al. Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: randomized, double-blind, parallel-group, sham-controlled trial. Lancet Neurol 2010:70054–70055. [DOI] [PubMed]
  • 26.Langguth B, Tobias K, Marienhagen J, et al. Transcrauial magnetic stimulation for the treatment of tinnitus: effects on cortical excitability. BMC Neurosci. 2007;8:45–45. doi: 10.1186/1471-2202-8-45. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Clarke BM, Upton AR, Kamath MV, Al-Harbi T, Castellanos CM. Transcranial magnetic stimulation for migraine: clinical effects. J Headache Pain. 2006;7:341–346. doi: 10.1007/s10194-006-0329-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Loo CK, McFarquahar TF, Mitchell PB. A review of the safety of repetitive transcranial magnetic stimulation as a clinical treatment for depression. Int J Neuropsyhopharmacol. 2008;11:131–147. doi: 10.1017/S1461145707007717. [DOI] [PubMed] [Google Scholar]
  • 29.Schutter DJ. Antidepressant efficacy of high-frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double-blind sham-controlled designs: a meta-analysis. Psychol Med. 2009;39:65–75. doi: 10.1017/S0033291708003462. [DOI] [PubMed] [Google Scholar]
  • 30.Haut SR, Bigal ME, Lipton RB. Chronic disorders with episodic manifestations: focus on epilepsy and migraine. Lancet Neurol. 2006;5:148–157. doi: 10.1016/S1474-4422(06)70348-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Goadsby PJ, Lipton RB, Ferrari MD. Migraine—current understanding and treatment. N Engl J Med. 2002;346:257–270. doi: 10.1056/NEJMra010917. [DOI] [PubMed] [Google Scholar]
  • 32.de Vries B, Frants RR, Ferrari MD, van den Maagdenberg AM. Molecular genetics of migraine. Hum Genet. 2009;126:115–132. doi: 10.1007/s00439-009-0684-z. [DOI] [PubMed] [Google Scholar]
  • 33.Kennard C, Gawel M, Rudolph Nde M, Rose FC. Visual evoked potentials in migraine subjects. Res Clin Stud Headache. 1978;6:73–80. [PubMed] [Google Scholar]
  • 34.Gawel M, Connolly JF, Rose FC. Migraine patients exhibit abnormalities in the visual evoked potential. Headache. 1983;23:49–52. doi: 10.1111/j.1526-4610.1983.hed2302049.x. [DOI] [PubMed] [Google Scholar]
  • 35.Schoenen J, Timsit-Berthier M. Contingent negative variation: methods and potential interest in headache. Cephalalgia. 1993;13:28–32. doi: 10.1046/j.1468-2982.1993.1301028.x. [DOI] [PubMed] [Google Scholar]
  • 36.MaertensdeNoordhout A, Timsit-Berthier M, Timsit M, Schoene J. Contingent negative variation in headache. Ann Neurol. 1986;19:78–80. doi: 10.1002/ana.410190115. [DOI] [PubMed] [Google Scholar]
  • 37.Kropp P, Gerber WD. Is increased amplitude of contingent negative variation in migraine due to cortical hyperactivity or to reduced habituation? Cephalalgia. 1993;13:37–41. doi: 10.1046/j.1468-2982.1993.1301037.x. [DOI] [PubMed] [Google Scholar]
  • 38.Schoenen J, Wang W, Albert A, Delwaide PJ. Potentiation instead of habituation characterizes visual evoked potentials in migraine patients between attacks. Eur J Neurol. 1995;2:115–122. doi: 10.1111/j.1468-1331.1995.tb00103.x. [DOI] [PubMed] [Google Scholar]
  • 39.Vikelis M, Mitsikostas DD. The role of glutamate and its receptors in migraine. CNS Neurol Disord Drag Targets. 2007;6:251–257. doi: 10.2174/187152707781387279. [DOI] [PubMed] [Google Scholar]
  • 40.Sanchez-Del-Rio M, Reuter U, Moskowitz MA. New insights into migraine pathophysiology. Curr Opin Neurol. 2006;19:294–298. doi: 10.1097/01.wco.0000227041.23694.5c. [DOI] [PubMed] [Google Scholar]
  • 41.Cao Y, Welch KM, Aurora S, Vikingstad EM. Functional MRI-BOLD of visually triggered headache in patients with migraine. Arch Neurol. 1999;56:548–554. doi: 10.1001/archneur.56.5.548. [DOI] [PubMed] [Google Scholar]
  • 42.Bohotin V, Fumal A, Vandenheede M, et al. Effects of repetitive transcranial magnetic stimulation on visual evoked potentials in migraine. Brain. 2002;125:912–922. doi: 10.1093/brain/awf081. [DOI] [PubMed] [Google Scholar]
  • 43.Ayata C, Jin H, Kudo C, Dalkara T, Moskowitz MA. Suppression of cortical spreading depression in migraine prophylaxis. Ann Neurol. 2006;59:652–661. doi: 10.1002/ana.20778. [DOI] [PubMed] [Google Scholar]
  • 44.Cutrer FM, Sorensesn AG, Weisskoff RM, et al. perfusion-weighted imaging defects during spontaneous migraine aura. Ann Neurol. 1998;43:25–31. doi: 10.1002/ana.410430108. [DOI] [PubMed] [Google Scholar]
  • 45.Hadjikhani N, Sanchez Del Rio M, Wu O, et al. mechanisms of migraine aura revealed by functional MRI in human visual cortex. Proc Natl Acad Sci USA. 2001;98:46887–46892. doi: 10.1073/pnas.071582498. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 46.Leao AAP. Spreading depression of activity in cerebral cortex. J Neurophysiol. 1944;7:359–390. doi: 10.1152/jn.1947.10.6.409. [DOI] [PubMed] [Google Scholar]
  • 47.Bolay H, Reuter U, Dunn AK, Huang Z, Boas DA, Moskowitz MA. Intrinsic brain activity triggers trigeminal meningeal afferents in a migraine model. Nat Med. 2002;8:136–142. doi: 10.1038/nm0202-136. [DOI] [PubMed] [Google Scholar]
  • 48.Olesen J, Burstein R, Ashina M, Tfelt-Hansen P. Origin of pain in migraine: evidence for peripheral sensitisation. Lancet Neurol. 2009;8:679–690. doi: 10.1016/S1474-4422(09)70090-0. [DOI] [PubMed] [Google Scholar]
  • 49.Holland PR, Schembri CT, Fredrick JP, Goadsby PJ. Transcranial magnetic stimulation for the treatment of migraine aura. Cephalalgia. 2009;72:A250–A250. [Google Scholar]
  • 50.Keck ME, Welt T, Müller MB, et al. Repetitive transcranial magnetic stimulation increases the release of dopamine in the mesolimbic and mesostriatal system. Neuropharmacology. 2002;43:101–109. doi: 10.1016/S0028-3908(02)00069-2. [DOI] [PubMed] [Google Scholar]
  • 51.Strafella AP, Paus T, Barrett J, Dagher A. Repetitive transcranial magnetic stimulation of the human prefrontal cortex induces dopamine release in the caudate nucleus. I Neurosci. 2001;21:RC157–RC157. doi: 10.1523/JNEUROSCI.21-15-j0003.2001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 52.Michael N, Gosling M, Reutemann M, et al. Metabolic changes after repetitive transcranial magnetic stimulation (rTMS) of the left prefrontal cortex. A sham-controlled proton magnetic resonance spectroscopy (1H MRS) study of health brain. Eur J Neurosci. 2003;17:2462–2468. doi: 10.1046/j.1460-9568.2003.02683.x. [DOI] [PubMed] [Google Scholar]
  • 53.Brighina F, Palermo A, Daniele O, Aloisio A, Fierro B. High-frequency transcranial magnetic stimulation on motor cortex of patients affected by migraine with aura: a way to restore normal cortical excitability? Cephalalgia 2009 Apr 28; [Epub ahead of print]. [DOI] [PubMed]
  • 54.Mohamad YM, Kothari R, Hughes G, et al. Transcranial magnetic stimulation (TMS) relieves migraine headache. Headache. 2006;46:839–839. [Google Scholar]
  • 55.Mohammad TM, Hughes G, Nkrumah M, et al. Self-Administered transcranial magnetic stimulation (TMS) during the aura phase improved and aborts headache. Headache. 2006;46:857–857. [Google Scholar]
  • 56.Brighina F, Piazza A, Vitello G, et al. rTMS of the prefrontal cortex in the treatment of chronic migraine: a pilot study. I Neurol Sci. 2004;227:67–71. doi: 10.1016/j.jns.2004.08.008. [DOI] [PubMed] [Google Scholar]
  • 57.Teepker M, Hötzel J, Timmesfeld N, et al. Low-frequency rtms of the vertex in the prophylactic treatment of migraine. Cephalalgia 2009 Jun 8; [Epub ahead of print]. [DOI] [PubMed]
  • 58.Roth BJ, Pascual-Leone A, Cohen LG, Hallett M. The heating of metal electrodes during rapid-rate magnetic stimulation: a possible safety hazard. Electroenceph Clin Neurophysiol. 1992;85:116–123. doi: 10.1016/0168-5597(92)90077-O. [DOI] [PubMed] [Google Scholar]
  • 59.Ruohonen J, Ilmoniemi RJ. Physical principles for transcranial magnetic stimulation. In: Pascual-Leone A, Davey NJ, Rothwell J, Wassermann EM, Puri BK, editors. Handbook of Transcranial Magnetic Stimulation. New York: Oxford University Press; 2002. [Google Scholar]
  • 60.Elwassif MM, Kong Q, Vazquez M, Bikson M. Bio-heat transfer-model of deep brain stimulation-induced temperature changes. J Neural Eng. 2006;3:306–315. doi: 10.1088/1741-2560/3/4/008. [DOI] [PubMed] [Google Scholar]

Articles from Neurotherapeutics are provided here courtesy of Elsevier

RESOURCES