Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
Abstract
- 2025;9;243-247 High-Frequency Repetitive Transcranial Magnetic Stimulation at 20 Hz: A Case Series Evaluating Efficacy in Treatment-Resistant Migraine After 10 Hz Repetitive Transcranial Magnetic Stimulation Failure
Case Series
Praveen Khairkar, MD, Rajesh Khoiwal, MD, Ishu Bamal, MBBS, MD, Archish Khivsara, MD, Navendra Kumar Gupta, MD, Anurag Pateriya, MS, MCh, Rohan Modi, MD, Rajesh Khaikar, MTech, and Murtaza Peerzada, MSc.
BACKGROUND: High-frequency transcranial magnetic stimulation (TMS) interventions were approved for migraine headache by the US Food and Drug Administration since 2013; however, it is unclear if 10 Hz frequency repetitive TMS (rTMS) patient relapses, should frequency of TMS be enhanced to 20 Hz protocol? This case series addresses the effectiveness of 20 Hz frequency rTMS in treatment-refractory migraine patients.
CASE REPORT: Five voluntary treatment-refractory migraine patients, referred from Medicine, Neurology, and Neurosurgery departments with mean duration of 11.8 years of migraine, not responding to any medications and failed to respond to 10 Hz frequency standard international guidelines, were subjected to 20 Hz, 5 sessions in the first week followed by weekly sessions for additional 4 weeks.
CONCLUSIONS: Compared to initial 10 Hz treatment, 20 Hz rTMS significantly reduced both frequency and severity of migraine. Over a follow-up period of 3-6 months, patients exhibited lasting improvements, indicating that 20 Hz rTMS is an effective neuromodulation intervention for individuals with refractory migraines.
KEYWORDS: acceptability, effectiveness, rTMS neuromodulation, treatment-refractory migraine