***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Preventive pharmacotherapy for migraine is not satisfactory because of the low efficacy/tolerability ratio of many available drugs . Novel and more efficient preventive strategies are therefore warranted . Abnormal excitability of cortical areas appears to play a pivotal role in migraine pathophysiology . Transcranial direct current stimulation ( tDCS ) is a non-invasive and safe technique that is able to durably modulate the activity of the underlying cerebral cortex , and is being tested in various medical indications . The results of small open studies using tDCS in migraine prophylaxis are conflicting , possibly because the optimal stimulation setting s and the brain targets were not well chosen . We have previously shown that the cerebral cortex , especially the visual cortex , is hyperresponsive in migraine patients between attacks and provided evidence from evoked potential studies that this is due to a decreased cortical preactivation level . If one accepts this concept , anodal tDCS over the visual cortex may have therapeutic potentials in migraine prevention , as it is able to increase neuronal firing . Objective To study the effects of anodal tDCS on visual cortex activity in healthy volunteers ( HV ) and episodic migraine without aura patients ( MoA ) , and its potentials for migraine prevention . Methods We recorded pattern-reversal visual evoked potentials ( VEP ) before and after a 15-min session of anodal tDCS over the visual cortex in 11 HV and 13 MoA interictally . Then 10 MoA patients reporting at least 4 attacks/month subsequently participated in a therapeutic study , and received 2 similar sessions of tDCS per week for 8 weeks as migraine preventive therapy . Results In HV as well as in MoA , anodal tDCS transiently increased habituation of the VEP N1P1 component . VEP amplitudes were not modified by tDCS . Preventive treatment with anodal tDCS turned out to be beneficial in MoA : migraine attack frequency , migraine days , attack duration and acute medication intake significantly decreased during the treatment period compared to pre-treatment baseline ( all p < 0.05 ) , and this benefit persisted on average 4.8 weeks after the end of tDCS . Conclusions Anodal tDCS over the visual cortex is thus able to increase habituation to repetitive visual stimuli in healthy volunteers and in episodic migraineurs , who on average lack habituation interictally . Moreover , 2 weekly sessions of anodal tDCS had a significant preventive anti- migraine effect , proofing the concept that the low preactivation level of the visual cortex in migraine patients can be corrected by an activating neurostimulation . The therapeutic results indicate that a larger sham-controlled trial using the same tDCS protocol is worthwhile A recent fMRI study showed that dorsolateral prefrontal cortex ( DLPFC ) exerts an inhibitory control on pain pathways in humans . We investigated whether high-frequency rTMS over left DLPFC could ameliorate  chronic migraine .  Treatment consisted of 12 rTMS sessions , delivered in alternate days over left DLPFC . Sham rTMS was used as placebo .  Eleven patients were r and omly assigned to the rTMS ( n=6 ) or to the placebo ( n=5 ) treatment . Measures of attack frequency , headache index , number of abortive medications ( outcome measures ) were recorded in the month before , during and in the month after treatment . Subjects treated by rTMS showed a significant reduction of the outcome measures during and in the month after the treatment as compared to the month before treatment . No significant differences in the outcome measures were observed in the placebo group . High-frequency rTMS over left DLPFC was able to ameliorate chronic migraine .  This is in agreement with the suggested role of DLPFC in pain control We report the efficacy of three versus single session of 10 Hz repetitive transcranial magnetic stimulation ( rTMS ) in  chronic migraine ( CM ) and chronic tension-type headache ( CTTH ) . Ninety-eight patients with CM or CTTH were included and their headache frequency , severity , functional disability and number of abortive medications  were noted . Fifty-two patients were r and omly assigned to group I ( three true sessions ) and 46 to group II ( one true and two sham rTMS sessions ) treatment . 10 Hz rTMS comprising 600 pulses was delivered in 412.4 s on the left frontal cortex . Outcomes were noted at 1 , 2 and 3 months . The primary outcome was 50 % reduction in headache frequency , and secondary outcomes were improvement in severity , functional disability , abortive drugs and side effects . The baseline headache characteristics were similar between the two groups . Follow up at different time points revealed significant improvement in headache frequency , severity , functional disability and number of abortive drugs compared to baseline in both group I and group II patients , although these parameters were not different between the two groups . In group I , 31 ( 79.4 % ) had reduction of headache frequency and 29 ( 74.4 % ) converted to episodic headache . In group II , these were 24 ( 64.8 % ) and 22 ( 59.2 % ) , respectively . In chronic migraine , the severity of headache at 2 months reduced in group I compared to group II ( 62.5 vs 35.3 % ; P = 0.01 ) . Both single and three sessions of 10 Hz rTMS were found to be equally effective in CM and CTTH , and result ed in conversion of chronic to episodic headache in 67.1 % patients Objective To evaluate the efficacy and tolerability of single pulse transcranial magnetic stimulation ( sTMS ) for the preventive treatment of migraine . Background sTMS was originally developed for the acute treatment of migraine with aura . Open label experience has suggested a preventive benefit . The objective of this trial was to evaluate the efficacy and tolerability of sTMS for migraine prevention . Methods The e Neura S pringTMS P ost-Market O bservational U .S. S tudy of Migrain e ( ESPOUSE ) Study was a multicenter , prospect i ve , open label , observational study . From December 2014 to March 2016 , patients with migraine ( n = 263 ) were consented to complete a 1-month baseline headache diary followed by 3 months of treatment . The treatment protocol consisted of preventive ( four pulses twice daily ) and acute ( three pulses repeated up to three times for each attack ) treatment . Patients reported daily headache status , medication use , and device use with a monthly headache diary . The primary endpoint , mean reduction of headache days compared to baseline , was measured over the 28-day period during weeks 9 to 12 . The primary endpoint was compared to a statistically-derived placebo estimate ( performance goal ) . Secondary endpoints included : 50 % responder rate , acute headache medication consumption , HIT-6 , and mean reduction in total headache days from baseline of any intensity . Results Of a total of 263 consented subjects , 229 completed a baseline diary , and 220 were found to be eligible based on the number of headache days . The device was assigned to 217 subjects ( Safety Data Set ) and 132 were included in the intention to treat Full Analysis Set . For the primary endpoint , there was a −2.75 ± 0.40 mean reduction of headache days from baseline ( 9.06 days ) compared to the performance goal ( −0.63 days ) ( p < 0.0001 ) . The 50 % responder rate of 46 % ( 95 % CI 37 % , 56 % ) was also significantly higher ( p < 0.0001 ) than the performance goal ( 20 % ) . There was a reduction of −2.93 ( 5.24 ) days of acute medication use , headache impact measured by HIT-6 , −3.1 ( 6.4 ) ( p < 0.0001 ) , and total headache days of any intensity −3.16 days ( 5.21 ) compared to the performance goal ( −0.63 days ) ( p < 0.0001 ) . The most common adverse events were lightheadedness ( 3.7 % ) , tingling ( 3.2 % ) , and tinnitus ( 3.2 % ) . There were no serious adverse events . Conclusions This open label study suggests that sTMS may be an effective , well-tolerated treatment option for migraine prevention . Trial registration number Repetitive transcranial magnetic stimulation ( rTMS ) is an emerging treatment for pain but there is no class 1 study on its role in migraine prophylaxis . In this study we report the efficacy and safety of high-rate rTMS in migraine prophylaxis . Adult migraine patients having > 4 attacks/month were r and omized to high-rate rTMS or sham stimulation . Stimulation in the form of 10 Hz rTMS , 600 pulses in 10 trains were delivered to the hot spot of the right abductor digiti minimi in 412 s. Three sessions were delivered on alternate days . The outcome was defined at 1 month . The primary outcome measures were reduction in headache frequency and severity > 50 % as assessed by the Visual Analogue Scale ( VAS ) . The secondary outcome measures were functional disability , rescue medication and adverse events .  Fifty patients each were r and omized to rTMS or sham stimulation . The baseline characteristics of rTMS and sham stimulation groups were similar . At 1 month , headache frequency ( 78.7 vs. 33.3 % ; P = 0.0001 ) and VAS score ( 76.6 vs. 27.1 % ; P = 0.0001 ) improved significantly in the patients receiving rTMS compared to those in the sham stimulation group . Functional disability also improved significantly in rTMS group ( P = 0.0001 ) . Only one patient following rTMS developed transient drowsiness and was withdrawn from the study . This study provides evidence of the efficacy and safety of 10 Hz rTMS in migraine prophylaxis Background Single pulse transcranial magnetic stimulation ( sTMS ) is a novel treatment for  acute migraine .  Previous r and omised controlled data demonstrated that sTMS is effective and well tolerated in the treatment of migraine with aura . The aim of the programme reported here was to evaluate patient responses in the setting of routine clinical practice . Methods Migraine patients with and without aura treating with sTMS had an initial review ( n = 426 ) and training call , and then participated in telephone surveys at week six ( n = 331 ) and week 12 during a 3-month treatment period ( n = 190 ) . Results Of patients surveyed with 3 month data ( n = 190 ; episodic , n = 59 ; chronic , n = 131 ) , 62 % reported pain relief , finding the device effective at reducing or alleviating migraine pain ; in addition there was relief reported of associated features : nausea- 52 % ; photophobia- 55 % ; and phonophobia- 53 % . At 3 months there was a reduction in monthly headache days for episodic migraine , from 12 ( median , 8–13 IQ range ) to 9 ( 4–12 ) and for chronic migraine , a reduction from 24 ( median , 16–30 IQ range ) to 16 ( 10–30 ) . There were no serious or unanticipated adverse events . Conclusions TMS may be a valuable addition to options for the treatment of both episodic and chronic migraine Background Chronic migraine is a prevalent disabling disease , with major health-related burden and poor quality of life . Long-term use of preventive medications carries risk of side effects . Objectives The aim of this study was to compare repetitive transcranial magnetic stimulation ( rTMS ) to botulinum toxin-A ( BTX-A ) injection as preventive therapies for chronic migraine . Methods A pilot , r and omized study was conducted on a small-scale sample of 29 Egyptian patients with chronic migraine , recruited from Kasr Al-Aini teaching hospital outpatient clinic and diagnosed according to ICHD-III ( beta version ) . Patients were r and omly assigned into two groups ; 15 patients received BTX-A injection following the Phase III Research Evaluating Migraine Prophylaxis Therapy injection paradigm and 14 patients were subjected to 12 rTMS sessions delivered at high frequency ( 10 Hz ) over the left motor cortex ( MC , M1 ) . All the patients were requested to have their 1-month headache calendar , and they were subjected to a baseline 25-item ( beta version ) Henry Ford Hospital Headache Disability Inventory ( HDI ) , Headache Impact Test ( HIT-6 ) , and visual analogue scale assessment of headache intensity . The primary efficacy measures were headache frequency and severity ; secondary measures were 25-item HDI , HIT-6 , and number of acute medications . Follow-up visits were scheduled at weeks 4 , 6 , 8 , 10 , and 12 after baseline visit . Results A reduction in all outcome measures was achieved in both the groups . However , this improvement was more sustained in the BTX-A group , and both the therapies were well tolerated . Conclusion BTX-A injection and rTMS have favorable efficacy and safety profiles in chronic migraineurs . rTMS is of comparable efficacy to BTX-A injection in chronic migraine therapy , but with less sustained effect The objective was to assess the impact of transcranial magnetic stimulation ( TMS ) on pain and the autonomic nervous system ( ANS ) in migraine . Fortytwo people [ mean age 41.43±11.69 ( SD ) years , 36 females ] were r and omised into high vs. low TMS stimulation groups and received 2 brief pulses of TMS . Thirty-three ( 33/42 ) individuals had heart-rate variability assessed , before and after stimulation 
    Output:
    
Of all TMS and tDCS modalities , rTMS is most promising with moderate evidence that it contributes to reductions in headache frequency , duration , intensity , abortive medication use , depression , and functional impairment .
However , only few studies reported changes greater than sham treatment .