Randomized, proof-of-principle clinical trial of active transcranial magnetic stimulation in chronic migraine

Date
2014-05-01Author
Conforto, Adriana B.
Amaro, Edson
Goncalves, Andre L.
Mercante, Juliane P. P.
Guendler, Vera Z.
Ferreira, Josione R.
Kirschner, Clara C. F. B.
Peres, Mario F. P. [UNIFESP]
Type
ArtigoISSN
0333-1024Is part of
CephalalgiaDOI
10.1177/0333102413515340Metadata
Show full item recordAbstract
Background High-frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex (rTMS-DLPFC) is an effective treatment for depression. Preliminary studies indicated beneficial effects of rTMS-DLPFC on pain relief in patients treated for depression, and in patients with chronic migraine.Methods in this randomized, double-blind, parallel-group, single-center, proof-of-principle clinical trial, we tested the hypothesis that 23 sessions of active rTMS-DLPFC delivered over eight weeks would be feasible, safe and superior to sham rTMS to decrease the number of headache days in 18 patients with chronic migraine without severe depression. Per-protocol analysis was performed.Results rTMS-DLPFC applied over eight weeks was feasible and safe in patients with chronic migraine. Contrary to our primary hypothesis, the number of headache days decreased significantly more in the sham group than in the group treated with active rTMS-DLPFC at eight weeks. Average decrease in headache days was >50% in the sham group, indicating a powerful placebo response. Pain intensity improved in both groups to a similar extent.Conclusions Positive results of M1 stimulation in other studies, and the absence of significant benefits of active high-frequency rTMS of the DLPFC in the present study, point to M1 as a more promising target than the DLPFC, for larger trials of noninvasive brain stimulation in patients with chronic migraine.
Citation
Cephalalgia. London: Sage Publications Ltd, v. 34, n. 6, p. 464-472, 2014.Keywords
Placebodorsolateral prefrontal cortex
transcranial magnetic stimulation
chronic migraine
pain
Sponsorship
Albert Einstein Israelite Hospital Teaching and Research Institute/Instituto de Ensino e Pesquisa do Hospital Israelita Albert EinsteinConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
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