J Headache Pain.  2010 Dec;11(6):505-12. Epub 2010 Aug 17. Effects of high-frequency repetitive transcranial magnetic stimulation of primary motor cortex on laser-evoked potentials in migraine. de Tommaso M, Brighina F, Fierro B, Francesco VD, Santostasi R, Sciruicchio V, Vecchio E, Serpino C, Lamberti P, Livrea P. Source Neurophysiopathology of Pain Unit, Neurological and Psychiatric Sciences Department, Neurological Clinic, Policlinico, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy. m.detommaso@neurol.uniba.it Abstract The aim of this study was to examine the effects of high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) of the left primary motor cortex (M1) on subjective pain and evoked responses induced by laser stimulation (LEPs) of the contralateral hand and supraorbital zone in a cohort of migraine patients without aura during the inter-critical phase, and to compare the effects with those of non-migraine healthy controls. Thirteen migraine patients and 12 sex- and age-matched controls were evaluated. Each rTMS session consisted of 1,800 stimuli at a frequency of 5 Hz and 90% motor threshold intensity. Sham (control) rTMS was performed at the same stimulation position. The vertex LEP amplitude was reduced at the trigeminal and hand levels in the sham-placebo condition and after rTMS to a greater extent in the migraine patients than in healthy controls, while the laser pain rating was unaffected. These results suggest that HF rTMS of motor cortex and the sham procedure can both modulate pain-related evoked responses in migraine patients. Headache.  2010 Jul;50(7):1153-63. Epub 2010 Jun 10. Transcranial magnetic stimulation for migraine: a safety review. Dodick DW, Schembri CT, Helmuth M, Aurora SK. Source Mayo Clinic, Phoenix, AZ, USA. Abstract OBJECTIVE: To review potential and theoretical safety concerns of transcranial magnetic stimulation (TMS), as obtained from studies of single-pulse (sTMS) and repetitive TMS (rTMS) and to discuss safety concerns associated with sTMS in the context of its use as a migraine treatment. METHODS: The published literature was reviewed to identify adverse events that have been reported during the use of TMS; to assess its potential effects on brain tissue, the cardiovascular system, hormone levels, cognition and psychomotor tests, and hearing; to identify the risk of seizures associated with TMS; and to identify safety issues associated with its use in patients with attached or implanted electronic equipment or during pregnancy. RESULTS: Two decades of clinical experience with sTMS have shown it to be a low risk technique with promise in the diagnosis, monitoring, and treatment of neurological and psychiatric disease in adults. Tens of thousands of subjects have undergone TMS for diagnostic, investigative, and therapeutic intervention trial purposes with minimal adverse events or side effects. No discernable evidence exists to suggest that sTMS causes harm to humans. No changes in neurophysiological function have been reported with sTMS use. CONCLUSIONS: The safety of sTMS in clinical practice, including as an acute migraine headache treatment, is supported by biological, empirical, and clinical trial evidence. Single-pulse TMS may offer a safe nonpharmacologic, nonbehavioral therapeutic approach to the currently prescribed drugs for patients who suffer from migraine. Headache: The Journal of Head and Face Pain Volume 39 Issue 8 Page 567  – September 1999 doi:10.1046/j.1526-4610.1999.3908567.x

Treatment of Migraine With Pulsing Electromagnetic Fields: A Double-Blind, Placebo-Controlled Study

Richard A. Sherman, PhD; Nancy M. Acosta, BS; Linda Robson, BA

The effect of exposure to pulsing electromagnetic fields on migraine activity was evaluated by having 42 subjects (34 women and 8 men), who met the International Headache Society’s criteria for migraine, participate in a double-blind, placebo-controlled study. Each subject kept a 1-month, pretreatment, baseline log of headache activity prior to being randomized to having either actual or placebo pulsing electromagnetic fields applied to their inner thighs for 1 hour per day, 5 days per week, for 2 weeks.After exposure, all subjects kept the log for at least 1 follow-up month. During the first month of follow-up, 73% of those receiving actual exposure reported decreased headaches (45% good decrease, 14% excellent decrease) compared to half of those receiving the placebo (15% worse, 20% good, 0% excellent). Ten of the 22 subjects who had actual exposure received 2 additional weeks of actual exposure after their initial 1-month follow-up. All showed decreased headache activity (50% good, 38% excellent). Thirteen subjects from the actual exposure group elected not to receive additional exposure. Twelve of them showed decreased headache activity by the second month (29% good, 43% excellent). Eight of the subjects in the placebo group elected to receive 2 weeks of actual exposure after the initial 1-month follow-up with 75% showing decreased headache activity (38% good, 38% excellent).In conclusion, exposure of the inner thighs to pulsing electromagnetic fields for at least 3 weeks is an effective, short-term intervention for migraine, but not tension headaches. Curr Rev Pain. 1999;3(5):342-347.   Sphenopalatine Ganglion Analgesia. Day M. Texas Tech University Health Sciences Center, Department of Anesthesiology, 3601 4th Street, Room 1C282, Lubbock, TX 79430, USA. The sphenopalatine ganglion and its involvement in the pathogenesis of pain has been the subject of debate for the last 90 years. The ganglion is a complex neural center composed of sensory, motor, and autonomic nerves, which makes it difficult to determine its pathophysiology. Current indications for blockade of the sphenopalatine ganglion include sphenopalatine and trigeminal neuralgia, migraine and cluster headaches, and atypical facial pain. Methods of blockade use local anesthetics, steroids, phenol, and conventional radiofrequency and electromagnetic field- pulsed radiofrequency lesioning. The techniques for blockade range from superficial to highly invasive. Efficacy studies, though few and small, show promise in patients who have failed pharmacologic or surgical therapies. Anesth Pain Control Dent. 1992 Spring;1(2):85-9.

Headache: The Journal of Head and Face Pain

Volume 38 Issue 3 Page 208  – March 1998 doi:10.1046/j.1526-4610.1998.3803208.x

Initial Exploration of Pulsing Electromagnetic Fields for Treatment of Migraine

Richard A. Sherman, PhD; Linda Robson, BA; Linda A. Marden, MD

Two studies were conducted during which 23 patients with chronic migraine were exposed to pulsing electromagnetic fields over the inner thigh. In an open study, 11 subjects kept a 2-week headache log before and after 2 to 3 weeks of exposure to pulsing electromagnetic fields for 1 hour per day, 5 days per week. The number of headaches per week decreased from 4.03 during the baseline period to 0.43 during the initial 2-week follow-up period and to 0.14 during the extended follow-up which averaged 8.1 months. In a double-blind study, 9 subjects kept a 3-week log of headache activity and were randomly assigned to receive 2 weeks of real or placebo pulsing elactromagnetic field exposures as described above. They were subsequently switched to 2 weeks of the other mode, after which they kept a final 3-week log. Three additional subjects in the blind study inadvertently received half-power pulsing electromagnetic field exposures. The 6 subjects exposed to the actual device first showed a change in headache activity from 3.32 per week to 0.58 per week. The 3 subjects exposed to only half the dose showed no change in headache activity. Large controlled studies should be performed to determine whether this intervention is actually effective

The management of craniofacial pain in a pain relief unit.

Hillman L, Burns MT, Chander A, Tai YM.

Russells Hall Hospital, Dudley, United Kingdom.

This paper reports the results of 34 craniofacial pain sufferers who were treated at the Dudley Pain Relief Unit over a 1-year period. Most of the patients were referred by their general medical practitioners. They were adults representing all age groups, with a female-male ratio of 4:1. The average history of pain was 5.5 years. Neuralgic pain (as distinct from temporomandibular joint dysfunction syndrome, migrainous disorders, and pain of iatrogenic origin) was most frequently seen. Oral drug therapy, local injection of corticosteroids and analgesics, peripheral neurolysis, magnetotherapy, hypnotherapy, and acupuncture were the lines of management available. By the end of this study period, pain had been relieved or eliminated in 30 of the patients (88%).