title: Add-on deep Transcranial Magnetic Stimulation (dTMS) for the treatment of chronic migraine: A preliminary study.
abstract: BACKGROUND
  Deep Transcranial Magnetic Stimulation (dTMS) can be an alternative treatment to relieve pain in chronic migraine (CM). 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
  We randomized 14 patients with International Classification of Headache Disorders, 3rd Edition (ICHD-3) treatment-resistant CM to add-on dTMS (n=7) or standard abortive or preventive antimigraine treatment (n=7). Three sessions of alternate day 10Hz 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 dTMS showed 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.
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Rapinesi
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy; Department of Psychiatric Rehabilitation, P. Alberto Mileno Onlus Foundation, Vasto, Italy. Electronic address: antonio.delcasale@uniroma1.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Del Casale
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Scatena
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Kotzalidis
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Di Pietro
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Vittoria Rachele
authors.initials: VR
authors.lastname: Ferri
authors.affiliation: Department of Neurology and Psychiatry, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Bersani
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Brugnoli
authors.affiliation: ATID Ltd. Advanced Technology Innovation Distribution, Rome, Italy.
authors.forename: Ruggero Nessim
authors.initials: RN
authors.lastname: Raccah
authors.affiliation: Department of Life Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Zangen
authors.affiliation: Department of Neurology and Psychiatry, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferracuti
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Orzi
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Girardi
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Sette
mesh_terms: D002908:Chronic Disease; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D065908:Transcranial Direct Current Stimulation
keywords: Chronic migraine; Deep transcranial magnetic stimulation (dTMS); Dorsolateral prefrontal cortex (DLPFC); Treatment-resistant migraine