Efficacy of continuous theta burst stimulation of the primary motor cortex in reducing migraine frequency: A preliminary open-label study

Background Theta burst stimulation is a type of pattern-specific repetitive transcranial magnetic stimulation that requires less stimulation time and lower intensity to induce long-lasting effects comparable to those of other repetitive transcranial magnetic stimulation protocols. This pilot study investigated whether continuous theta burst stimulation (cTBS) on the primary motor cortex reduced headache frequency in patients with migraine. Methods Nine patients with migraine were recruited into our study. All patients received 20 cTBS sessions (bursts of 3 50-Hz TMS pulses at 200-ms intervals for 40 seconds), administered every weekday for 4 consecutive weeks. All patients kept headache diaries for 4 weeks before stimulation (baseline; T1), during stimulation (T2), and 4 weeks after stimulation (T3). The primary outcome measures were the changes of total headache and migraine days from baseline (Wilcoxon signed-rank test; T2 and T3 vs. T1). Results The number of total headache days was reduced at T2 and T3 compared with T1 [9.4 ± 6.2 days ( p = 0.024) and 8.7 ± 10.1 days ( p = 0.012) vs. 13.4 ± 10.1 days]. The number of migraine days was also reduced at T2 and T3 compared with T1 [2.9 ± 2.7 days ( p = 0.021) and 1.0 ± 1.6 days ( p = 0.008) vs. 8.6 ± 8.7 days]. Conclusion Our results indicate that cTBS on the primary motor cortex might reduce the number of total headache and migraine days in patients with migraine. However, large-scale randomized controlled trials are necessary to further validate the findings.