Table 1.
Single-pulse transcranial magnetic stimulation (sTMS) and repetitive transcranial magnetic stimulation (rTMS) studies as prophylactic treatment of migraine
| Authors | Participants | Study | Treatment | Results |
|---|---|---|---|---|
| Bhola et al. [12] | M = 190: MO or MA = 59, CM = 131 (87 with MOH) | Open-label. Telephone survey | V1 | The device was effective at reducing or alleviating their migraine pain in 62% of patients; 59% of patients reported a reduced number of headache days, and 72% reported lower HIT-6 score post-TMS after 12-weeks use |
| Starling et al. [13] | M = 132 | Multicenter, prospective, single arm, open-label, observational study | V1 | ↓in headache days, in days with acute headache medication, and ↓from baseline of HIT-6 impact questionnaire. The 50% responder rate of 46%. Overall, there were no serious adverse events reported |
| Brighina et al. [14] | CM = 12: sham (n = 6) or rTMS (n = 6) | Open-label sham-controlled | HF-rTMS over the left dorsolateral prefrontal cortex |
↓ attacks frequency at 2 months with rTMS (53%) than sham (7%); therapeutic gain of 46% ↓ abortive pills and headache index with rTMS, not with sham |
| Misra et al. [15] | M medically refractory = 51 | Open-label study | HF-rTMS over the left frontal cortex | ↓ headache frequency at 1 month with rTMS (80.4%); all secondary outcome measures (severity, functional disability, migraine index, and rescue medications) were significantly lower in the rTMS group compared to the sham group |
| Misra et al. [16] | M = 100 (93 MO, 7 MA, 60 CDH, 28 MOH): sham (n = 50) or rTMS (n = 50) | Randomised, placebo-controlled double-blind study | HF-rTMS over the left frontal cortex |
↓ headache frequency at 1 month with sham (33.3%) than rTMS (78.7%); therapeutic gain of 45.4%; improvement in headache severity in rTMS group (CDH > episodic M) compared to sham All secondary outcome measures (VAS score and functional disability) were significantly lower in the rTMS group compared to the sham group |
| Rapinesi et al. [24] | CM + MOH = 14 | Open-label study | HF-deep-rTMS over the bilateral dorsolateral prefrontal cortex | Compared to the sham group, patients receiving real rTMS showed ↓ of pain intensity, frequency of attacks, analgesic overuse, and depressive symptoms during treatment and one month later |
| Teo et al. [23] | CM = 9 | Randomised, sham-controlled, study | HF-rTMS over the right M1 | No significant differences in outcome measures were found between real and sham rTMS |
| Conforto et al. [22] | CM = 14 | Randomised, double-blind, parallel-group, single-centre, clinical trial | HF-rTMS over the left dorsolateral prefrontal cortex |
↓ headache days at 2 months with sham (58.1%) than rTMS (15.0%); therapeutic gain of 43.1% ↓ pain intensity at 2 months in both treatment groups; ↓ BDI at 2 months with sham, but not with rTMS; ↓ STAI and MIDAS in both groups |
| Hodaj et al. [25] | CH = 19 | Open-label study | HF-rTMS M1 contralateral to pain | ↓ of the intensity of permanent pain, the paroxysmal pain, the daily number of painful attacks, and the percentage of responders from baseline to day 15 |
| Kalita et al. [17] | CM + CTTH = 52 | Randomised sham-controlled trial | HF-rTMS over the left frontal region | Both 1-session and 3-sessions or rTMS ↓ frequency of headache, % of patients remitted to an episodic form, duration and severity of headache, and number of abortive medications |
| Kalita et al. [10] | M = 94 | Randomised open-label study | HF-rTMS over the left frontal region | VAS score improved by more than 50% in the 78.6% of patients in the real rTMS group, and in the 34.2% of the patients receiving sham stimulation |
| Shehata et al. [18] | CM = 14 | Open-label, randomised study | HF-rTMS over the left M1 | ↓ of the headache days and severity, quality of life, and headache disability score in the first 2 months equally in both patients receiving rTMS and botulinum toxin type A. At the month 3 the clinical improvement was maintained by botulinum toxin type A, but not by rTMS |
| Granato et al. [19] | CM + MOH = 14 | Randomised, sham-controlled double-blind study | HF-rTMS over the dorsolateral prefrontal cortex | ↓ of mean number of headache days, symptomatic drug intake, headache hours and MIDAS in the two groups without significant differences. Mean number of headache days reduced at T3 by 45,5% and 40% in HF-rTMS and sham groups, respectively |
| Kumar et al. [20] | CM = 20 | Randomised, sham-controlled double-blind study | HF-rTMS over the left M1 | ↓ in headache frequency in the group receiving real rTMS, but not in the group receiving sham rTMS. Any between groups difference was observed for the variables MIDAS, state and trait STAI, and BDI-II scores |
BDI Beck Depression Inventory, CCH chronic cluster headache, CDH chronic daily headache, CH chronic headache, CM chronic migraine, DLPFC dorsolateral prefrontal cortex, CTTH chronic tension-type headache, HF high-frequency, M1 primary motor cortex, M migraineurs patients, MA migraine with aura, MIDAS migraine disability assessment, MO migraine without aura, MOH medication overuse headache, S1 primary somatosensory cortex, STAI State-Trait Anxiety Inventory, tDCS transcranial direct current stimulation, V1 primary visual cortex, VAS visual analogue scale