- OBJECTIVE: To evaluate rTMS safety and efficacy (in term of headache intensity and frequency reduction and improvement in quality of life) in Chronic Migraine. BACKGROUND: Chronic migraine (CM) is a disabling condition and a challenging therapeutic problem since prophylactic drugs often have inadequate response or unacceptable side effects. A few pilot studies have explored the possibility of applying repetitive transcranial magnetic stimulation (rTMS) in migraine for acute or chronic treatment with controversial results. DESIGN/METHODS: Thirty patients (median age 34 years, 70% female), affected by CM -resistant to preventive pharmacological therapies and in clinical stability in the previous 3 months- participated to the study. rTMS was applied to prefrontal areas at 110% motor threshold intensity and 20 Hz frequency. Three rTMS sessions per week were performed for six weeks with a follow-up visit at 4, 8, 12, 24 weeks, after end of treatment. Patients underwent headache diary assessment, MIDAS, BDI, SF36. RESULTS: No side effects were evident during the study. Ten patients presented with a significative reduction (50%) in headache days (p CONCLUSIONS: The use of rTMS could be a major step forward in CM treatment, particularly in patients where available drugs are ineffective, poorly tolerated or contraindicated rTMS may be able in modulating the activity of cortico-subcortical and cortico-cortical pathways involved in pain control. Disclosure: Dr. Dalla Libera has nothing to disclose. Dr. Colombo has nothing to disclose. Dr. Nuara has nothing to disclose. Dr. Spagnolo has nothing to disclose. Dr. Straffi has nothing to disclose. Dr. Chieffo has nothing to disclose. Dr. Coppi has nothing to disclose. Dr. Di Maggio has nothing to disclose. Dr. Ferrari has nothing to disclose. Dr. Houdayer has nothing to disclose. Dr. Velikova has nothing to disclose. Dr. Zangen has received (royalty or license fee or contractual rights) payments from NIH and the Weizmann Institute. Dr. Zangen holds stock and/or stock options in NIH and the Weizmann Institute, which sponsored research in which Dr. Zangen was involved as an investigator. Dr. NIH and the Weizmann Institute holds stock and/or stock options in NIH and the Weizmann Institute. Dr. Zangen has received research support from NIH, the Weizmann Institute and Teva Neuroscience. Dr. Comi has received personal compensation for activities with Novartis, Teva Neuroscience, Sanofi-Aventis Pharmaceuticals, Inc., Merck Serono, and Bayer Schering. Dr. Leocani has nothing to disclose.