TMS for Migraine Headaches

TMS Treatment for Migraine Headaches

Migraine sufferers are benefiting from an exciting new therapy in TMS Treatment for Migraine Headaches. A migraine is a severe headache with disabling characteristics. It is characterized by a recurrent unilateral or bilateral (one or two-sided) pulsating headaches. It is estimated that more than 1 billion people suffer from migraines worldwide. The known disabling effect of the disease poses enormous socio-economic costs on society (1). The global community of healthcare providers and researchers have acknowledged the absence of a meaningful progress in diagnosis and treatment over the last half century (2). One primary reason for the absence of scientific advances in this area is poor understanding of the pathophysiology.

Could fMRI Brain Imaging
Diagnose Migraine

Functional connectivity (FC) is a measure of cooperation between different brain regions. Measurements of FC have been a powerful tool offered by resting-state functional magnetic resonance imaging (rsfMRI). This technology allows scientists to obtain an accurate account of the human brain’s functional organization. Studies in migraine patients using rsfMRI have found abnormal FC within different members of the most important networks of the human brain, called default mode network (DMN).

An increase in functional connectivity in a few regions have been observed. These regions are right cerebellum, right calcarine gyrus, left inferior occipital gyrus, left postcentral gyrus, right parahippocampal gyrus, and right posterior cingulate gyrus. Interestingly, some regions have shown decreased connectivity. These regions are right superior occipital gyrus, right postcentral gyrus, left superior frontal gyrus, right orbital inferior frontal gyrus, left middle occipital gyrus, left middle frontal gyrus and left inferior frontal gyrus. As such FC offers a new tool for bringing the pathophysiology of migraine to build a targeted treatment of migraine.

How rsfMRI Can Diagnose and TMS Can Help Treat Migraine?

We have used FC through rsfMRI, to bring the understanding of the underlying physiological mechanism of migraine to clinical setting. Other scientists have done similar work with great outcomes (3; 4; 5). We have seen a close association between the loci of nodes of DMN and migraine. Other scientists have also confirmed that DMN is involved in migraine (6; 7).

To do this, we use transcranial magnetic stimulation (TMS) for stimulation of specific targets which are chosen by constructing brain network maps and looking at the network dynamics. This way, we let the brain activity that is causing the migraine to guide the TMS treatment. We also use the coordinates of decreased grey matter volume in specific brain regions of migraine patients to monitor the efficacy of the treatment.

We measure efficacy of our treatments by using the migraine coordinates and their connections to the known location in left extrastriate visual cortex. Others have found that these relate with (8) overlying dorsal V3 and V3A subregions. We also use FC with bilateral insula and with the hypothalamus for guiding treatment. Our use of FC to visual cortex V3/V3A, has been able to treat the cortical based depression in migraine. Our work has been based on consensus of migraine neuroimaging research and treats migraine-specific targets by TMS.


1.      Vo, P., Fang, J., Bilitou, A., Laflamme, A. K., and Gupta, S. (2018). Patients’ perspective on the burden of migraine in Europe: a cross-sectional analysis of survey data in France, Germany, Italy, Spain, and the United Kingdom. J. Headache Pain 19:82. doi: 10.1186/s10194-018-0907-6

2.       Ashina, M., Buse, D. C., Ashina, H., Pozo-Rosich, P., Peres, M. F. P., Lee, M. J., et al. (2021a). Migraine: integrated approaches to clinical management and emerging treatments. Lancet 397, 1505–1518. doi: 10.1016/S0140-6736(20)32342-4

3.       Colombo, B., Rocca, M. A., Messina, R., Guerrieri, S., and Filippi, M. (2015). Resting-state fMRI functional connectivity: a new perspective to evaluate pain modulation in migraine? Neurol. Sci. 36(Suppl. 1), 41–45. doi: 10.1007/s10072-015-2145-x

4. Ellingson, B. M., Hesterman, C., Johnston, M., Dudeck, N. R., Charles, A. C., and Villablanca, J. P. (2019). Advanced Imaging in the evaluation of migraine headaches. Neuroimaging Clin. N. A. 29, 301–324. doi: 10.1016/j.nic.2019.01.009

5.       Kim, J. H., Kim, S., Suh, S. I., Koh, S. B., Park, K. W., and Oh, K. (2010). Interictal metabolic changes in episodic migraine: a voxel-based FDG-PET study. Cephalalgia 30, 53–61. doi: 10.1111/j.1468-2982.2009.01890.x

6.       Chong, C. D., Schwedt, T. J., and Hougaard, A. (2019). Brain functional connectivity in headache disorders: a narrative review of MRI investigations. J. Cereb. Blood Flow Metab. 39, 650–669. doi: 10.1177/0271678X17740794

7.       Argaman, Y., Kisler, L. B., Granovsky, Y., Coghill, R. C., Sprecher, E., Manor, D., et al. (2020). The endogenous analgesia signature in the resting brain of healthy adults and migraineurs. J. Pain 21, 905–918. doi: 10.1016/j.jpain.2019.12.006

8. Hu Su, Hao Zeqi, Li Mengting, Zhao Mengqi, Wen Jianjie, Gao Yanyan, Wang Qing, Xi Hongyu, Antwi Collins Opoku, Jia Xize, Ren Jun.  Resting-state abnormalities in functional connectivity of the default mode network in migraine: A meta-analysis. Frontiers in Neuroscience, 17, 2023  

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Meet Neurotherapeutix NYC

Neurotherapeutix is the leading clinic for functional imaging guided transcranial magnetic stimulation (TMS), a safe, innovative, and non-invasive methodology for treating a wide range of acute and chronic mental disorders and brain injuries. Our advanced fMRI technology allows us to map the brain for the… Learn More »

Published: March 24, 2023NYC

Last Reviewed: January 10, 2024


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