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Unexpected Reduction in Migraine and Psychogenic Headaches Following rTMS Treatment for Major Depression: A Report of Two Cases

Published online by Cambridge University Press:  07 November 2014

Abstract

Our objective is to report a coincident reduction in headache pain in patients treated with repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD). Two patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of MDD, non-responsive to prior antidepressant treatment who were enrolled in a sham-controlled, double-blind study of rTMS for MDD. After the study, it was revealed that both were in the active-treatment arm. Both patients suffered from near daily headaches and kept logs of headache frequency and severity before, during, and after the study. Headache pain was significantly reduced under double-blind conditions with rTMS treatment, but returned to baseline following cessation of rTMS treatment. Ultimately, when receiving rTMS post-study as a maintenance intervention for MDD (~2 rTMS sessions/week), the positive effects on headache amelioration were sustained. Headache pain is frequently comorbid with mood disorders and has been reported as the most common side effect with rTMS. In these subjects, rTMS was, in fact, associated with relief of depressive symptoms and preexisting headache pain. This indicates that rTMS may be beneficial for both disorders in some patients.

Type
Case Report
Copyright
Copyright © Cambridge University Press 2007

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References

REFERENCES

1.Molgat, CV, Patten, SB. Comorbidity of major depression and migraine-a Canadian population-based study. Can J Psychiatry. 2005;50:832837.CrossRefGoogle ScholarPubMed
2.Roth, BJ. Mechanisms for electrical stimulation of excitable tissue. Crit Rev Biomed Eng. 1994;22:253305.Google ScholarPubMed
3.Amassian, VE, Cracco, RQ, Maccabee, PJ, Cracco, JB, Rudeli, AP, Eberle, L. Transcranial magnetic stimulation in study of the visual pathway. J Clin Neurophysiol. 1998;15:288304.CrossRefGoogle ScholarPubMed
4.Klein, E, Kreinin, I, Chistyakov, A, et al.Therapeutic efficacy of right prefrontal slow repetitive transcranial magnetic stimulation in major depression: a double-blind controlled study. Arch Gen Psychiatry. 1999;56:315320.CrossRefGoogle ScholarPubMed
5.George, MS, Wassermann, EM, Kimbrell, TA, et al.Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: a placebo-controlled crossover trial. Am J Psychiatry. 1997;154:17521756.CrossRefGoogle ScholarPubMed
6.Fitzgerald, PB, Brown, TL, Marston, NA, Daskalakis, ZJ, De Castella, A, Kulkami, J. Transcranial magnetic stimulation in the treatment of depression: a double-blind, placebo-controlled trial. Arch Gen Psychiatry. 2003;60:10021008.CrossRefGoogle ScholarPubMed
7.Avery, DH, Holtzheimer, PE 3rd, Fawaz, W, et al.A controlled study of repetitive transcranial magnetic stimulation in medication-resistant depression. Biol Psychiatry. 2006;59:187194.CrossRefGoogle Scholar
8.O'Reardon, J, Solvason, HB, Janicak, PG, et al.Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry. In press.Google Scholar
9.Wassermann, EM. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996. Bectroencephalogr Clin Neurophysiol. 1998;108:116.CrossRefGoogle ScholarPubMed
10.Brighine, F, Piazza, A, Vitello, G, et al. rTMS of the prefrontal cortex in the treatment of chronic migraine: a pilot study. J Neurol Sci. 2004;227:6771.CrossRefGoogle Scholar
11.Lorenz, J, Minoshima, S, Casey, KL. Keeping pain out of mind: the role of the dorsolateral prefrontal cortex in pain modulation. Brain. 2003;126:10791091.CrossRefGoogle ScholarPubMed
12.Ben-Shachar, D, Gazawi, H, Riboyad-Levin, J, Klein, E. Chronic repetitive transcranial magnetic stimulation alters beta-adrenergic and 5-HT2 receptor characteristics in rat brain. Brain Res. 1999;816:7883.CrossRefGoogle ScholarPubMed
13.Gur, E, Lerer, B, van de Kar, LD, Newman, ME. Chronic rTMS induces subsensitivity of post-synaptic 5-HT1A receptors in rat hypothalamus. Int J Neuropsychopharmacol. 2004;7:335340.CrossRefGoogle ScholarPubMed