Poor Tolerance of Motor Cortex rTMS in Chronic Migraine.
BACKGROUND
Two small studies had evaluated the efficacy of rTMS in migraine. One tested high frequency rTMS over the dorsolateral prefrontal cortex while the other evaluated 1 Hz rTMS over the vertex.


OBJECTIVE
To test the feasibility of 10 Hz rTMS of motor cortex as an adjunctive therapy in patients with chronic migraine Materials and Methods: We randomized (2:1 ratio) chronic migraine patients on medical preventive treatment to receive either rTMS or sham therapy for 10 sessions. rTMS (80% resting motor threshold, 10Hz, 20 trains, 5 secs/train, inter-train interval 1 min, total 1000 stimuli/session) was applied over the right motor cortex.


RESULTS
Nine patients were randomized. Six received rTMS and three had sham therapy. Three patients in the rTMS arm withdrew from the study due to increased headache frequency and discomfort from the treatment. The remaining six cases (3 rTMS, 3 sham) completed the study. The study was prematurely stopped due to the significant worsening of headache from rTMS. No significant differences in outcome measures were found between real and sham rTMS.


CONCLUSIONS
Although the study was terminated prematurely, the high dropout rate (50%) due to worsening headaches suggested that rTMS over the motor cortex is poorly tolerated in chronic migraine.
Lecturer, School of Medical and Applied Sciences , Central Queensland University, Australia .
Wei-Peng
WP
Teo
Medical Technologist, Neurodiagnostic Laboratory, National University Hospital , Singapore .
Aravinda
A
Kannan
Consultant Neurologist, Ara Damansara Medical Centre , Malaysia .
Pei-Kee
PK
Loh
Senior Consultant, Rehabilitative Medicine, Assistant Professor, National University Hospital;Yong Loo Lin School of Medicine, National University of Singapore , Singapore .
Effie
E
Chew
Senior Consultant, Division of Neurology, Assistant Professor, National University Hospital;Yong Loo Lin School of Medicine, National University of Singapore , Singapore .
Vijay Kumar
VK
Sharma
Senior Consultant, Division of Neurology, Assistant Professor, National University Hospital;Yong Loo Lin School of Medicine, National University of Singapore , Singapore .
Yee-Cheun
YC
Chan
Adverse effect; Central sensitization; Chronic migraine; Cortical excitability; Headache; rTMS