Effectiveness and Tolerability of Repetitive Transcranial Magnetic Stimulation for Preventive Treatment of Episodic Migraine: A Single Centre, Randomised, Double-Blind, Sham-Controlled Phase 2 Trial (Magnet-EM).

Abstract

Background This is a phase II randomised, double-blind, placebo-controlled trial to evaluate the effectiveness and tolerability of repetitive transcranial magnetic stimulation for preventive treatment of episodic migraine among migraine subjects. Methods Subjects age 18 to 60 years will undergo a baseline evaluation to ascertain the diagnosis of migraine based on International Classification of Headache Disorder 3 rd Edition (ICHD-3). Only those who fulfil the ICHD-3 criteria for episodic migraine and compliant to the headache diary during a month run-in period will be enrolled. A total of 76 subjects will be randomised to receive either transcranial magnetic stimulation or placebo for 5 sessions within 2 weeks duration. Follow up sessions will be conducted monthly for three consecutive months. Prior to treatment, subjects will be required to fill up questionnaires and undergo few procedures such as electroencephalography, transcranial doppler ultrasound and biochemical analysis for serum serotonin, serum calcitonin-gene related peptide and serum beta-endorphin. These procedures will be repeated post-treatment during their last visit. The primary outcome measure of this study is the difference in mean monthly migraine days at baseline and at month 1, 2 and 3 after treatment sessions. Discussion Following evidence from previous studies showing restoration of dorsolateral prefrontal cortex (DLPFC) activation to near normal level, the rTMS intervention will target left DLPFC in this study. Meanwhile, in terms of treatment frequency, the least number of sessions reported which proved to be effective in treating migraine was three session of rTMS given in alternate days. Hence, for this study, an intermediate duration of treatment sessions is selected. It is set to five treatment sessions given within 2 weeks duration.