Add-on deep Transcranial Magnetic Stimulation (dTMS) for the treatment of chronic migraine: Apreliminary study

Background:

Deep Transcranial Magnetic Stimulation (dTMS) can be an alternative treatment to relieve paininchronic migraine (CM).

Objective:

The aim of this study was to evaluate the effect of high-frequency dTMS in add-on to standard treatment for CM in patients not responding to effective abortive or preventive drug treatment.

Methods:

Forteen patients with International Classification of Headache Disorders, 3rdEdition (ICHD-3) treatment-resistant CM were randomized to add-on dTMS (n=7) or standard abortive or preventive antimigraine treatment (n=7). Three sessions of alternate day 10 Hz dTMS consisting of 600 pulses in 10 trains were delivered to the dorsolateral prefrontal cortex (DLPFC), bilaterally, but with left hemisphere prevalence, for 12 sessions spread over one month.

Results:

The add-on dTMS treatment was well-tolerated. Patients treated with dTMSshowed significant reduction of pain intensity, frequency of attacks, analgesic overuse, and depressive symptoms during treatment and one month later, compared to the month preceding treatment and at the same time-points compared to the control group.

Conclusions:

As compared to standard pharmacological treatment alone, add-on high-frequency dTMS of the bilateral DLPFC reduced the frequency and intensity of migraine attack, drug overuse, and depressive symptoms. This study supports the add-on dTMS treatment in treatment-resistant CM.

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