Effect of Repetitive Transcranial Magnetic Stimulation (RTMS) on EEG Changes, Sleep, Physical Activity and Psychological States of Migraine: A Randomised Controlled Trial (Magnet-EM)

Migraine is one of the leading causes of morbidity in the world and the cause of health care visits (Seidel et al 2017). Progression of the disease usually leads to unfavourable outcomes including medication overused and tendency towards psychiatric comorbidities. Moving towards preventive medicine, this study measured the effect of rTMS on migraine as secondary prevention. In this article, per protocol analysis was used. It is a double-blinded randomised, controlled trial Sixty-four migraine subjects were included in the analysis, randomized into placebo group and treatment group. Maximum Intensity of pulse is decided by muscle twitching when single pulse RTMS is delivered. 20 Hz RTMS is delivered on dorsolateral prefrontal cortex (dLPFC) with 80% of maximum intensity in 2000 pulse of 25 seconds interval for twenty minutes each session. EEG, PSQI, GPAQ and DASS-21 questionnaires and headache diary were delivered to the participants pre- and post-RTMS. The study found a statistically significant difference in the proportion of photic driving response pre- and post-rTMS, p = .005, ?p² = .336) in the rTMS group vs. placebo. Sleep, anxiety, physical activity and stress scores in the rTMS group vs placebo has no significant changes but there was a statistically significant reduction in the depression score (X² = 9.60, p= 0.022). To conclude, rTMS on dLPFC may offer beneficial effects to reduce depressive symptoms in migraine. Although this is an early finding, the current rTMS study protocol could be used by clinician as an early adjunctive treatment for migraine patient with comorbid depression.