title: Beta-blocker migraine prophylaxis affects the excitability of the visual cortex as revealed by transcranial magnetic stimulation.
abstract: The objective of this study is to assess effects of beta-blocker migraine prophylaxis on cortical excitability determined by transcranial magnetic stimulation (TMS). Phosphene and motor thresholds (PT, MT) were investigated in 29 patients with migraine, in 15 of them prior to and following preventive medication with metoprolol and in 14 patients without prophylaxis. Following prophylaxis headache frequency significantly decreased (p = 0.005) and mean PT were significantly increased (51.5 ± 7.5 vs. 63.6 ± 8.4%) compared to patients without preventive treatment (53.7 ± 5.3 vs. 52.3 ± 6.3%; p = 0.040). Mean MT did not significantly differ either between groups or due to treatment. In the group of all patients, a significant inverse correlation between headache frequency and the level of PT was found (R = -0.629; p < 0.01). There was, however, no significant correlation in the subgroups of patients. We conclude that (a) clinical efficacy of beta-blocker treatment in migraine could be (at least partly) linked to its ability to modulate the excitability of the visual cortex and (b) the PT determined by TMS appears suitable to assess the effects of prophylaxis on cortical excitability in the individual patient. This may be useful in clinical trials investigating migraine preventive drugs.
authors.affiliation: Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany. marcus.gerwig@uk-essen.de
authors.forename: Marcus
authors.initials: M
authors.lastname: Gerwig
authors.forename: L
authors.initials: L
authors.lastname: Niehaus
authors.forename: P
authors.initials: P
authors.lastname: Stude
authors.forename: Z
authors.initials: Z
authors.lastname: Katsarava
authors.forename: H C
authors.initials: HC
authors.lastname: Diener
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D019054:Evoked Potentials, Motor / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D008881:Migraine Disorders / Q000517:prevention & control*; D010719:Phosphenes / Q000187:drug effects; D050781:Transcranial Magnetic Stimulation; D014793:Visual Cortex / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists; D008790:Metoprolol
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