Unexpected Reduction in Migraine and Psychogenic Headaches Following rTMS Treatment for Major Depression: A Report of Two Cases

ABSTRACTOur objective is to report a coincident reduction in headache pain in patients treated with repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD). Two patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of MDD, non-responsive to prior antidepressant treatment who were enrolled in a sham-controlled, double-blind study of rTMS for MDD. After the study, it was revealed that both were in the active-treatment arm. Both patients suffered from near daily headaches and kept logs of headache frequency and severity before, during, and after the study. Headache pain was significantly reduced under double-blind conditions with rTMS treatment, but returned to baseline following cessation of rTMS treatment. Ultimately, when receiving rTMS post-study as a maintenance intervention for MDD (~2 rTMS sessions/week), the positive effects on headache amelioration were sustained. Headache pain is frequently comorbid with mood disorders and has been reported as the most common side effect with rTMS. In these subjects, rTMS was, in fact, associated with relief of depressive symptoms and preexisting headache pain. This indicates that rTMS may be beneficial for both disorders in some patients.

Relation of Histamine Headache to Post-Contusional and Psychogenic Headache

Von Storch has induced headache by the sudden intravenous injection of minute amounts of histamine phosphate in three groups of persons—the first group consisting of those subject to migraine, the second group composed of those suffering from chronic recurrent non-migraine headache, and the third group consisting of those not subject to headache. He has found that in persons subject to migraine the headache produced by histamine is frequently similar in character to their habitual headache (though bilateral), while in those subject to chronic recurrent non-migraine headache the experimental headache is only occasionally similar to their usual headache. From the evidence presented by him, linking migraine and histamine, the latter would appear to be a useful drug for distinguishing migraine from other forms of recurrent headache. Using a technique similar to his, experiments were performed at this centre to determine the relation of histamine headache to post-contusional and psychogenic headaches, and the results are worth recording.