Transcranial Magnetic Stimulation: Basic Principles and Clinical Applications in Migraine.


Barker AT; Shields K. Institution Barker, Anthony T. Consultant Clinical Scientist in the Department of Medical Physics and Clinical Engineering at Sheffield Teaching Hospit als NHS Foundation Trust, Professor Associate at the University of Sheffield Medical School, UK. Shields, Kevin. Consultant Neurologist and Clinical Neurophysiolog ist at The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.


Transcranial Magnetic Stimulation: Basic Principles and Clinical Applications in Migraine. [Review] Source Headache. 57(3):517-524, 2017 Mar.

Abstract PURPOSE:

Transcranial magnetic stimulation (TMS) is a neurophysiological technique with a long established pedigree of safety, tolerability, and efficacy. Initially TMS was used to study the function of the cerebral cortex, but it has now become a treatment for migraine, one of the most common and debilitating neurological conditions. In this review we discuss the scientific background and development of the technique. We explore its application for the treatment of migraine and ponder the possible mechanisms of action in this most common neurological condition .


The generation of brief magnetic pulses by a suitable coil can induce electrical fields in the body. When applied to the cerebral cortex, currents are painlessly induced in cortical neurons. These currents can lead to neuronal depolarization and may influence cortical excitability by means that are as yet not fully understood. This ability to modulate cortical excitability has been exploited as a treatment for migraine with aura. Aura is implicated in the pathophysiology of migraine. Experimental studies have shown that transcranial magnetic pulses can block waves of cortical spreading depression – the experimental equivalent of migrainous aura.


Migraine is a debilitating condition characterized by headache, nausea, and sensory hypersensitivity. It may affect up to 15% of the population, yet current drug treatments are often poorly tolerated. Clinical studies have shown that TMS is an effective treatment for migraine. In addition, it has the added advantages of being safe and wel l tolerated by patients. Authors Puledda F; Goadsby PJ. Institution Puledda, Francesca. Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College (F. Puledda). Goadsby, Peter J. Headache Group, NIHR-Wellcome Trust King’s Clinical Research Facility, King’s College Hospital, London, United Kingdom . Title An Update on Non-Pharmacological Neuromodulation for the Acute an d Preventive Treatment of Migraine. [Review] Source Headache. 57(4):685-691, 2017 Apr.

Abstract OBJECTIVE: To review current neuromodulation treatments available for migraine therapy, both in the acute and preventive setting. METHODS: The published literature was reviewed for studies reporting the effects of different neuromodulation strategies in migraine with and without aura. The use of non-invasive: single pulse transcranial magneti c stimulation, non-invasive vagal nerve stimulation, supraorbital nerve stimulation, and transcranial direct current stimulation, as well as invasive methods such as occipital nerve stimulation and sphenopalatine ganglion stimulation, are assessed.


The available evidence shows that non-invasive techniques represent promising treatment strategies, whereas an invasive approach should only be used where patients are refractory to other preventives, including non-invasive methods.


Neuromodulation is emerging as an exciting approach to migraine therapy, especially in the context of failure of commonly used medicines or for patients who do not tolerate common side effects. More studies with appropriate blinding strategies are needed to confirm the results of these new treatment opportunities. **(tDCS)


Cosentino G; Brighina F; Talamanca S; Paladino P; Vigneri S; Basch i R; Indovino S; Maccora S; Alfonsi E; Fierro B. Title Reduced threshold for inhibitory homeostatic responses in migraine motor cortex? A tDCS/TMS study. Source Headache. 54(4):663-74, 2014 Apr. Abstract


Neurophysiological studies in migraine have reported conflicting findings of either cortical hyper- or hypoexcitability. In migraine with aura (MwA) patients, we recently documented an inhibitory response to suprathreshold, high-frequency