Thesis (Ph.D.) - Cairo University - Faculty of Physical Therapy - Department of Physical Therapy for Neuromuscular and Neurosurgery

Migraine is a common primary headache disorder with no underlying identifiable pathological cause. It affects 11% of the total adult population creating a significant socio-economic burden on society. Transcranial magnetic stimulation (TMS) is non - invasive tool, alter the excitability of the cerebral cortex, as well as of intracortical inhibitory circuits. It is a therapeutic modality that is being developed as both an acute and preventive treatment for migraine. This study aimed to determine and investigate the effects of low - frequency rTMS over occipital lobe in the management of migraine headache. Thirty migraine patients participated in the study, their age ranged from 20-50 y. The patients were assigned into three equal groups (G1, G2 and G3). Group one (G1) was treated by daily twelve low frequency (1Hz) rTMS over occipital lope. Group two (G2) was treated by a designed physical therapy program and sham rTMS. Group three (G3) was treated by the same designed physical therapy program and rTMS. Pain intensity of headache was assessed by visual analogue scale pre, immediately post treatment and after three months of post treatment. Level of serum serotonin was measured pre and immediately post treatment. The frequency of headache attacks was assessed pre and post three months. Significant improvements were observed in the three studied groups. Level of serum serotonin significantly elevated in G3 that received both TMS and a designed physical therapy program than in both G1 (TMS) and G2 (a designed physical therapy program). It was slightly elevated in G2 than G1 (p = 0.197). Pain intensity decreased in the three studied groups immediately post treatment and three months post treatment. The percentage of improvement was nearly similar in G1; G2 and G3.A significant decrease in frequency of attack three months post treatment in the three studied groups. It was significantly decreased in G2 than G1 and in G3 than G1 with no difference between G2 and G3. Low frequency rTMS over occipital cortex is effective in improving migraine headache with no additional benefit when compared to manipulative therapy alone, in the treatment of migraine headaches in adults. Serotonin is an objective and accurate method to assess the severity of migraine headache

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