Migraine and dTMS

In recent years, migraine has become one of the most common nervous system diseases in the world with a steady increase. Peter Goadsby, a Neurology Professor in King’s College London, defined migraine as “a hereditary-oriented headache progressing with sensory disorders .

This is the instability experienced by the brain while coping with the sensory data received externally, and this instability may be affected by physiological changes like sleep, exercise and hunger. Migraine generally appears during the childhood, adolescence or young adulthood periods.

The migraine history present in the family, age (generally, the most severe times are the ages around 30), gender (observable at higher rates in women), and hormonal changes increase the risk of migraine. Moreover, it tends to increase during the periods of pregnancy or menopause.

Hormonal changes in women (fluctuations in estrogen levels), excessively salty foods, additives, alcohol and caffeinated beveragesstress, sensory stimulants (bright lights, sunlight, high volume, strong odors, etc.), changes in the sleep order, physical actors and environmental changes are known to be triggering migraine.

Migraine may generally cause aches in the form of unilateral severe throbbing, or a sensation of pulse. This condition is generally accompanied by nausea, vomiting, and excessive sensitivity for light and sound. Migraine attacks may cause serious and extremely severe aches that can last for hours or even for days.

Known as “aura”, the warning symptoms may occur before or with headaches. They may be in visual or sensory form. These may include photopsia on one side of the face, in the arm or leg, or blind spots or tingling. Migraine aura generally occurs prior to the start of headaches, or during the initial development phase of the disease. They last for quite a short time, generally 20 minutes, or somewhere between 10-30 minutes.

Although many different methods are used for the treatment of migraine, the most commonly implemented method is the pharmacological one, namely medication. Pharmacological treatments are divided into two groups: acute and preventive strategies. Acute treatment is implemented to alleviate the patient and to re-regulate the brain functions when ache attacks occur, while preventive treatment is administered to decrease the frequency and severity of the ache attacks whether or not there are aches in the daily routine.

While drugs help prevent some migraines and make them less painful, they become insufficient in the treatment is some cases. Therefore, in recent years, some treatment methods have been searched as an alternative to pharmacological treatments.

Transcranial magnetic stimulation/excitation (TMS) stands for the magnetic field created by the electric current occurring along a coil wrapped around scalp or skull and is a harmless method capable of measuring the neural transmission, activation and inhibition in the cerebral cortex. Different kinds of it are used in the treatment of migraine.

Deep Transcranial Magnetic Stimulation (dTMS) is another type of TMS and is capable of stimulating the deeper parts of the brain via electromagnetic currents.

Prof. Antonio Del Casale and his team from the Sapienza University of Rome conducted a research on the effectiveness of the deep TMS (dTMS) on the chronic migraine treatment. The participants consisted of 14 people who meet the standard criteria and suffered from chronic migraine at the beginning of the study. All participants had been suffering from headaches for at least 15 days, which significantly reduced their body functionality and life quality.

The participants did not respond to three (or more) different treatment types before. While the participants continued to take drugs during the 4-week treatment period, 7 people constituting the experiment group also received high frequency dTMS treatment for 12 days.

The deep TMS treatment was carried out at a higher frequency on the left part of the brain, and in a bilateral mode over the prefrontal area (DLPFC) . The deep TMS effect was evaluated through the use of the standard grading scales which are pre-treatment, post-treatment and one month after the treatment. No side effects were observed during the study. According to the results of the study, the headache, frequency of headaches, excessive use of painkillers, and the depressive indicators caused by the ache in the subject group that also received the dTMS treatment showed a meaningful and statistically apparent decrease compared to the control group that only took drugs and to the gradings carried out prior to the study. This decrease was observed during the study and remained the same even one month later.

Although in need of more studies, the researchers stated that the dTMS is an effective and safe method of treatment as an additional treatment to the medication for patients having chronic migraine.