Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow, 226014, India,
J Neurol. 2013 Nov;260(11):2793-801. doi: 10.1007/s00415-013-7072-2. Epub 2013 Aug 21.
Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for pain but there is no class 1 study on its role in migraine prophylaxis. In this study we report the efficacy and safety of high-rate rTMS in migraine prophylaxis. Adult migraine patients having >4 attacks/month were randomized to high-rate rTMS or sham stimulation. Stimulation in the form of 10 Hz rTMS, 600 pulses in 10 trains were delivered to the hot spot of the right abductor digiti minimi in 412 s. Three sessions were delivered on alternate days. The outcome was defined at 1 month. The primary outcome measures were reduction in headache frequency and severity >50 % as assessed by the Visual Analogue Scale (VAS). The secondary outcome measures were functional disability, rescue medication and adverse events. Fifty patients each were randomized to rTMS or sham stimulation. The baseline characteristics of rTMS and sham stimulation groups were similar. At 1 month, headache frequency (78.7 vs. 33.3 %; P = 0.0001) and VAS score (76.6 vs. 27.1 %; P = 0.0001) improved significantly in the patients receiving rTMS compared to those in the sham stimulation group. Functional disability also improved significantly in rTMS group (P = 0.0001). Only one patient following rTMS developed transient drowsiness and was withdrawn from the study. This study provides evidence of the efficacy and safety of 10 Hz rTMS in migraine prophylaxis.
重复经颅磁刺激（rTMS）是一种新兴的疼痛治疗方法，但目前还没有关于其在偏头痛预防中的作用的 1 类研究。在这项研究中，我们报告了高频 rTMS 在偏头痛预防中的疗效和安全性。每月发作>4 次的成年偏头痛患者被随机分为高频 rTMS 组或假刺激组。刺激形式为 10 Hz rTMS，10 个脉冲的 10 个脉冲串，在 412 s 内传递到右侧外展趾短肌的热点。每隔一天进行三次治疗。结果在 1 个月时定义。主要疗效指标是视觉模拟量表（VAS）评估的头痛频率和严重程度>50%的减少。次要疗效指标是功能障碍、急救药物和不良事件。每组 50 例患者被随机分为 rTMS 组或假刺激组。rTMS 组和假刺激组的基线特征相似。在 1 个月时，rTMS 组的头痛频率（78.7%比 33.3%；P=0.0001）和 VAS 评分（76.6%比 27.1%；P=0.0001）显著改善，而假刺激组则无明显改善。rTMS 组的功能障碍也显著改善（P=0.0001）。只有 1 例 rTMS 治疗后出现短暂困倦，退出研究。这项研究为 10 Hz rTMS 在偏头痛预防中的疗效和安全性提供了证据。
