Coil orientation affects pain sensation during single-pulse transcranial magnetic stimulation over Broca’s area

OBJECTIVE: Pain sensation at the site of stimulation is a side effect of transcranial magnetic stimulation (TMS). The purpose of this study was to investigate how or whether the coil orientation affected TMS-induced pain on Broca’s area (BA) or primary motor cortex (M1). METHODS: In Experiment 1, we measured pain thresholds during single-pulse TMS delivered over BA or left M1 at seven coil orientation angles (−90° to 90°, in 30° increments) relative to the posterior-anterior (PA) orientation. In Experiment 2, we evaluated subjective pain intensity when delivering TMS at an intensity of 110% of the resting motor threshold, which is commonly used in conventional TMS studies. RESULTS: In Experiment 1, we found a significant relationship between coil orientation and pain thresholds during BA stimulation but not M1 stimulation. During BA stimulation, pain thresholds were significantly lower when the coil orientation was 30° upward (−30° condition) relative to the PA orientation compared with 60° downward (60° condition). In Experiment 2, pain sensations were significantly stronger in the −30° condition compared with those in the 60° condition. We also confirmed that the averaged location of pain on the head in both conditions were more than 25 mm from the left lateral orbital rim. CONCLUSIONS: The coil orientation of TMS over BA affects pain sensations. This might be attributable to the activation of nociceptors and nociceptive fibers in the muscle tissues above BA, rather than the orbicularis oculi muscle. SIGNIFICANCE: Although the influence of coil orientation on the TMS efficacy is unclear, this study suggests that manipulating the orientation of the TMS coil may be helpful in reducing pain when applying TMS to BA.