Efficacy and safety of high-frequency repetitive transcranial magnetic stimulation (rTMS) for migraine: a meta-analysis of randomized controlled trials

To assess the efficacy and safety of high-frequency repetitive transcranial magnetic stimulation in the prevention or treatment of migraine by conducting a pooled analysis of relevant randomized controlled trials.

The PubMed, Embase, Cochrane, OVID, SCOPUS, Web of Science, and clinicaltrials.gov databases were systematically searched for randomized controlled trials (RCTs) comparing high-frequency rTMS and sham stimulation for the prevention or treatment of migraine. A meta-analysis of relevant outcome measures was performed using RevMan 5.3 software.

Eight RCTs with a total of 384 patients were included. A total of 23 patients dropped out, and thus, 361 patients were ultimately included for analysis. The high-frequency rTMS group had a lower frequency of attacks than the sham group (MD = − 5.10; 95% CI: − 8.10, − 2.09; P = 0.0009). The rTMS group has less intense headaches than the sham group (SMD = − 0.74; 95% CI − 1.04, − 0.44; P < 0.00001). High-frequency rTMS improved patient disability (SMD = − 0.45; 95% CI − 0.75, − 0.16; P = 0.003). High-frequency rTMS led to no advantage in reducing the number of abortive medications (MD = − 1.10; 95% CI − 3.28, 1.08; P = 0.32), but it increased the occurrence of adverse events (RR = 1.69; 95% CI 1.09, 2.64; P = 0.02).

High-frequency rTMS reduces the frequency of attacks and headache intensity in migraine patients and improves the patient’s disability, but it also increases adverse events.