The aim of the study was to examine the prophylactic role of repetitive transcranial magnetic stimulation (rTMS) on the frequency, and severity of migraine attacks in episodic migraineurs who failed medical treatment.

A group received 5 rTMS sessions, delivered over one week. Each rTMS session consisted of a single train of 900 total pulses over 3 minutes duration given at 5-Hz frequency and 100% motor threshold intensity and the placebo group received rTMS with the same stimulation frequency at a fixed intensity of 50% of the machine output

Inclusion Criteria:

• cases diagnosed as episodic migraine with or without aura according to the ICHD 3rd edition
• With a headache frequency of 4-14 per month for the last six months
• Patients who had either an unsatisfactory response, declined or were intolerant to at least two prophylactic medications.

Exclusion Criteria:

• Patients with past family history of seizures
• Other chronic pain disorders
• Severe depression (Beck Depression Inventory of 30 or more)
• Other significant neurologic or psychiatric diagnosis including substance misuse
• Metal implants in the head
• Pregnant or breastfeeding ladies
• Prior experience with TMS