Transcranial Magnetic Stimulation in Migraine: A New Therapy and New Insights into Pathogenesis

Transcranial magnetic stimulation (TMS) was first found to be effective in acute migraine 12 years ago, and subsequent studies have confirmed this benefit in approximately two -thirds of treated patients. High response rate, ease of application, and freedom from adverse effects combine to make TMS a natural front-line treatment for migraine, and its use should therefore be encouraged. In relation to the pathogenesis of migraine, the prompt relief of symptoms often observed with TMS is considered incompatible with an underlying neuroinflammatory process and with spreading depression as a cause of aura. Instead, the available evidence points to hyperexcitability of cortical neurons as the immediate cause of headache and any associated symptoms, although the factor(s) leading up to the hyperexcitability remain unclear.