Abstract
ObjectiveThe 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.MethodsA 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.ResultsThe 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).ConclusionHigh-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.Trial registrationClinicalTrials.gov, Identifier: NCT04031781. Registered 23 July 2019—retrospectively registered at https://clinicaltrials.gov/ct2/show/NCT04031781?term=Migraine+Prophylaxis&recrs=ce&type=Intr&cond=Migraine&rank=9
Highlights
The incidence of a new migraine diagnosis is increasing [1]
Most of the work done on the prophylactic role of repetitive transcranial magnetic stimulation (rTMS) targeted chronic migraineurs with conflicting results, apart from one study that recruited episodic and chronic migraineurs and reported positive results [7,8,9]
Patient selection Thirty-three consecutive cases diagnosed as episodic migraine with or without aura according to the The international classfication of Headache disorder (ICHD) third edition, with a headache frequency of 4–14 per month for the last 6 months and older than 16 years were recruited from the neurology and headache clinics in Ain Shams University Hospitals
Summary
Migraine is classified into an episodic and a chronic form based on the frequency of migraine attacks per month. Episodic migraine, which is considered as the milder form, has an annual conversion rate of 2.5% to chronic migraine [2]. Trials to improve the treatment outcomes of episodic migraines would decrease the overall disease burden. This is especially true given the limited effectiveness and poor tolerability of the currently available prophylactic medications [4]. Single-pulse and repetitive TMS have been recently tried in the acute and prophylactic management of migraine, respectively [5]. The results of the acute management trials were encouraging [6]. Most of the work done on the prophylactic role of rTMS targeted chronic migraineurs with conflicting results, apart from one study that recruited episodic and chronic migraineurs and reported positive results [7,8,9]
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