Dramatic placebo effect of high frequency repetitive TMS in treatment of chronic migraine and medication overuse headache

Chronic migraine (CM) is often associated with medication overuse headache (MOH). Few small trials have been conducted on Transcranial Magnetic Stimulation for CM treatment, but results are conflicting. Aim of the study was to investigate the effects of high frequency of repetitive Transcranial Magnetic Stimulation (hf-rTMS) in the dorsolateral prefrontal cortex combined with strongly suggesting to avoid medications overuse in patients suffering with CM and MOH. A six-month single-centre perspective randomized double-blinded study was conducted at the Headache Centre of Trieste. Patients suffering with CM and MOH were randomly enrolled in two groups to receive active hf-rTMS in DLPFC or sham hf-rTMS. Headache days (HD), headache hours (HH) and symptomatic drug intake (SDI) were recorded for 30\u202fdays before the beginning of stimulation (T0) and during the three following months (T3). Disability (MIDAS score) was evaluated at T0 and at the three-month follow-up visit. The primary outcome was the evaluation of reduction of HD. Reduction of SDI, HH and disability were considered as secondary outcomes. Out of 26 patients enrolled, 14 completed the study, 7 underwent hf-rTMS and 7 sham-TMS. There were no significant differences between groups at T0 in demographic data and headache measures. Mean number of HD, HH, SDI, and MIDAS similarly reduced in the two groups. Our study failed in demonstrating that hf-rTMS with detoxification advice could be better than detoxification advice alone in CM treatment. hf-rTMS carries a high potential of inducing placebo effect and this can be usefully leveraged to enhance patients' coping strategies

An fMRI study of musicogenic epilepsy: can the emotional components of music trigger the seizures?

Musicogenic epilepsy is a rare form of epilepsy. We describe a 36-years-old right-handed man, with right temporal lobe seizures since the age of 27 years. He was an amateur musician and realized that any music with a strong emotional charge was effective in precipitating seizures, even if it was only thought out. All of his seizures were musicogenic and started about 2 min after the beginning of the appropriate music. Anastasia song \u201cOverdue Goodbye\u201d was especially provocative even when he was playing guitar himself. Music without emotional charge (Battisti song \u201cLa canzone del sole\u201d, or disco music) was ineffective. The patient underwent brain MRI, neuropshycological tests and prolonged video-polygraphic recording. We performed fMRI to explore the location and extent of the eloquent areas activated during the playing of the two aforesaid songs: neutral music (Battisti song \u201cLa canzone del sole\u201d) and epileptogenic music (Anastasia song \u201cOverdue Goodbye\u201d). The listening of neutral music showed activated areas in the right temporal lobe in a region corresponding to the acoustic area. The listening of epileptogenic music showed a wider spreading of this area mainly towards the posterior part of the right temporal lobe up to the posterior pole of the right hemisphere, without a concomitant epileptic attack. The thinking of neutral music produced eloquent areas in the frontal pole, bilaterally, but no temporal activation was observed. The thinking of epileptogenic music caused a wide spreading of eloquent areas in the left hemisphere, from the very anterior frontal pole to the occipital one. Bilateral frontal activation was also present. The results are discussed in terms of emotional reaction to music as the stimulus effective in triggering musicogenic seizures