High frequency-rTMS of the left DLPFC relieve headaches and enhance frontal-temporal connectivity in migraine
Abstract
OBJECTIVE: Migraine is a neurological disorder linked to altered cortical excitability. High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) is a promising non-invasive method for modulating nociceptive circuits, yet its precise mechanisms remain unclear. This study applied HF-rTMS to the left dorsolateral prefrontal cortex (DLPFC) and assessed brain network changes using transcranial magnetic stimulation combined with electroencephalography (TMS-EEG).
METHODS: We analyzed dynamic brain connectivity in 15 migraine patients versus 15 healthy controls. A randomized, double-blind, sham-controlled trial evaluated a 14-day HF-rTMS (20 Hz) protocol in 28 migraine patients. Brain network reorganization and migraine severity, measured by the Visual Analog Scale (VAS) and monthly migraine days (MMD), were assessed both immediately after treatment and at a one-month follow-up.
RESULTS: Migraine patients exhibited reduced left DLPFC connectivity compared to healthy controls. HF-rTMS significantly increased frontal-temporal network connectivity, correlating with a marked reduction in VAS and MMD scores (p < 0.001).
CONCLUSION: These findings provide novel evidence that HF-rTMS targeting the left DLPFC effectively alleviates migraine symptoms by enhancing frontal-temporal cortical plasticity.
SIGNIFICANCE: This study highlights the potential of neuromodulation techniques in the treatment of migraine.
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 28 participants or records.
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