{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:14:21Z","timestamp":1790741661216,"version":"4.1.0"},"reference-count":29,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurology International"],"abstract":"<jats:p>Background: Migraine is a highly prevalent neurological disorder associated with substantial disability and socioeconomic burden. Although pharmacological therapies remain the mainstay of treatment, their effectiveness may be limited by incomplete response and adverse effects. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a non-invasive neuromodulatory technique that may modulate cortical excitability and pain-processing networks involved in migraine pathophysiology. This systematic review aimed to evaluate the current evidence regarding the efficacy and safety of rTMS compared with sham stimulation in individuals with migraine. Methods: A systematic search was conducted in PubMed (MEDLINE), PsycNet, and Ovid (including MEDLINE and Embase) from database inception to December 2025 in accordance with PRISMA 2020 guidelines. Studies investigating rTMS in adults with migraine and including a sham comparator were eligible for inclusion. Data regarding study design, participant characteristics, rTMS parameters, outcomes, and adverse events were extracted using a predefined template. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Results: Seven studies comprising a total of 301 participants were included. Most trials evaluated high-frequency rTMS targeting the dorsolateral prefrontal cortex. Across studies, rTMS was generally associated with reductions in migraine frequency and severity compared with sham stimulation, although results varied depending on stimulation parameters and study design. Treatment was consistently well tolerated, with only mild and transient adverse effects reported. However, considerable heterogeneity was observed in diagnostic criteria, stimulation protocols, outcome measures, and follow-up duration. Conclusions: Preliminary evidence suggests that rTMS may represent a promising and well-tolerated neuromodulatory approach for migraine management. Nevertheless, methodological variability, limited sample sizes, and concerns regarding risk of bias restrict definitive conclusions. Larger randomized controlled trials with standardized protocols and longer follow-up periods are needed to clarify the clinical role of rTMS in migraine treatment.<\/jats:p>","DOI":"10.3390\/neurolint18050080","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T13:32:22Z","timestamp":1777469542000},"page":"80","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Repetitive Transcranial Magnetic Stimulation in Migraine: Clinical Outcomes and Neurobiological Mechanisms\u2014A Systematic Review"],"prefix":"10.3390","volume":"18","author":[{"given":"Robert Constantin","family":"Zgarbura","sequence":"first","affiliation":[{"name":"Psychiatry Department, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leea Cristescu","family":"Rizea","sequence":"additional","affiliation":[{"name":"Psychiatry Department, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madalin","family":"Dinca","sequence":"additional","affiliation":[{"name":"Psychiatry Department, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6721-4754","authenticated-orcid":false,"given":"Alexandru","family":"Pavel","sequence":"additional","affiliation":[{"name":"FutureMeds, 031441 Bucharest, Romania"},{"name":"PAX Clinic, 020951 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana-Andreea","family":"Parliteanu","sequence":"additional","affiliation":[{"name":"Diabetes Department, Pneumology Institute \u201cMarius Nasta\u201d, 050159 Bucharest, Romania"},{"name":"Faculty of Medicine, University of Medicine and Pharmacy \u201cTitu Maiorescu\u201d, 040051 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jari","family":"Sabri","sequence":"additional","affiliation":[{"name":"Faculty of Physical Education and Sports, \u201cSpiru Haret\u201d University, 041905 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catalina","family":"Tudose","sequence":"additional","affiliation":[{"name":"Psychiatry Department, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/S0025-6196(11)60562-4","article-title":"The Impact of Migraine and the Effect of Migraine Treatment on Workplace Productivity in the United States and Suggestions for Future Research","volume":"84","author":"Burton","year":"2009","journal-title":"Mayo Clin. 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