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Background Repetitive transcranial magnetic stimulation (rTMS) over right posterior parietal cortex was shown to induce interference on visuospatial perception in healthy subjects. Transcranial direct current stimulation (tDCS) is another noninvasive brain stimulation technique that works modulating cortical activity. It is applied through easy to use, noncostly, and portable devices. Objective/Hypothesis The aim of the current study was to investigate if the novel approach of “dual” stimulation over parietal cortices compared with the unilateral (right) cathodal one is able to induce greater and/or longer-lasting neglect-like effects in normal subjects performing a computerized visuospatial task. Methods Eleven healthy subjects underwent a computerized visuospatial task requiring judgments about the symmetry of prebisected lines in baseline condition, during and after tDCS. Right cathodal and left anodal tDCS were simultaneously applied over homologue posterior parietal cortices in the “dual” approach, whereas right cathodal tDCS was used in the traditional unihemisphere stimulation. Results A significant rightward bias in symmetry judgments as compared with baseline and sham conditions was observed in both the stimulation approaches. With “dual” tDCS compared with cathodal stimulation the effect was stronger and appeared earlier, but no longer-lasting after effects were found. Conclusions We speculate that the resulting modulation of interhemispheric inhibition mediated the additional rightward bias in task performance for “dual” hemisphere compared with unihemisphere tDCS. If “dual” tDCS may better reproduce mechanisms underlying real lesions, it could provide a more suitable model for rehabilitation of negligent patients.

Background: Brief 5Hz repetitive transcranial magnetic stimulation (rTMS) trains at 120% of the resting- motorthreshold (RMT) intensity determine in healthy subjects a potentiation of motor evoked potentials (MEPs), likely due to short-term presynaptic plasticity facilitation. We recently showed paradoxical intensity-dependent MEP changes to 5Hz rTMS in migraine with MEP facilitation at 110% and inhibition at 130% RMT. This provides evidence of both hyper-responsivity and self-limiting hyperexcitability capacity in migraine, likely due to earlier activation of inhibitory homeostatic plasticity mechanisms. To explore this, we applied in migraineurs cathodal transcranial Direct Current Stimulation (tDCS) to reduce motor-cortical excitability and subsequently reassess motor-cortical response to 5Hz rTMS trains at 130% RMT- intensity. Methods: 10 migraine with aura patients received 5Hz rTMS of motor cortex at 130% RMT intensity (10 pulses), recording MEP from contralateral abductor pollicis brevis (APB). This protocol was preconditioned by cathodal tDCS (10 min, 1mA intensity). Sham cathodal tDCS was used as control. Results: As expected MEP amplitude decreased significantly during trains of 5Hz before tDCS preconditioning or with sham tDCS. Conversely, after inhibitory preconditioning with cathodal tDCS, 5Hz rTMS trains determined a reduction in the first MEP size and a trend toward MEP facilation during the trains. Conclusions: Inhibitory cathodal tDCS preconditioning is able to normalize the response of migraine motor-cortex to rTMS trains at 130% of RMT. This supports the hypothesis that in migraine motor cortex the mechanisms of short-term presynaptic plasticity evaluated by 5Hz rTMS trains could be affected intericatally by an abnormal increased cortical excitability level.

The trigeminal autonomic cephalalgias (TACs), including cluster headache, paroxysmal hemicrania and SUNCT, are characterized by the cardinal combination of short-lasting unilateral pain and autonomic phenomena affecting the head. Hemicrania continua (HC) shares many clinical characteristics with TACs, including unilateral pain and ipsilateral autonomic features. Nevertheless, HC is separately classified in the revised International Classification of Headache Disorders (ICHD-II). Here, we describe the case of a 45-year-old man presenting an unusual concurrence of different forms of primary headaches associated with autonomic signs, including subsequently ipsilateral cluster headache, SUNCT and HC. This report supports the theory that common mechanisms could be involved in pathophysiology of different primary headache syndromes.