Neuromodulation and Brain Stimulation for Migraine Pain

Migraines are throbbing, disabling headaches that can go on for several days. Neuromodulation is a type of therapy that may zap away the pain without the side effects of medications.

These treatments -- some of which require minor surgery -- use electronic or magnetic pulses to stimulate the nerves in your body or brain linked with migraine attacks. Some types of neuromodulation can ease pain. Others may prevent some migraines or end them quicker. One treatment uses magnets to help manage aura, the flashing lights and other visual disturbances some people have along with migraines.

Vagal Nerve Stimulation (VNS)

This uses electricity to stimulate the vagus nerve, a large, long bundle of fibers that runs from your brain through your body. You hold a small device against your neck, usually for two sessions lasting 90 to 120 seconds. You’ll likely feel only a mild buzzy twitching.

VNS may ease pain during an intense headache.

Transcutaneous Electrical Nerve Stimulation (TENS)

This treatment targets the trigeminal nerve, another large nerve linked with migraine. It was the first neuromodulation device approved by the FDA. You wear a plastic band on your forehead over the trigeminal nerve. The band sends a buzzy, painless electrical current. It activates painkilling receptors in your spinal cord and the brainstem. It runs for a set time of 20 minutes. You can adjust the intensity by raising or lowering the frequency.

Adults can use TENS every day to prevent migraines. One study showed that many people who wore the device daily saw their headache days drop by at least half.

Transcranial Magnetic Stimulation (TMS)

This brain stimulation therapy most often is used for mental disorders, like severe depression or anxiety. It can help when your migraine is about to come on or right when it starts. It was the first prescription medical equipment to treat migraine pain that follows an aura.

TMS for migraine treatment is usually done at home with a rented device. It sends a very quick and targeted magnetic pulse to the back of your brain, called the occipital cortex, responsible for vision.

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Sphenopalatine Ganglion (SPG) Stimulation

The SPG is a bundle of nerve cells behind your nose. These cells detect pain and connect with the trigeminal nerve, where headaches can form.

SPG stimulation requires surgery. A surgeon who specializes in the jaws and face implants a device about the size of a small nut through your mouth to the upper gum. A handheld controller placed against the cheek delivers signals that help shut down pain. The surgery doesn’t leave any visible scars.

SPG stimulation has not been cleared for migraine treatments in the U. S. but is under study. The European Union has approved it for cluster headaches, an extremely painful and rare condition that’s different from migraines.

Occipital Nerve Stimulation (ONS)

This is another surgical neuromodulation that’s not been approved by the FDA. It uses electrical leads implanted under the skin on the back of your head. They connect to a wire and battery inside your chest, hip, or belly. The battery sends electrical pulses straight to the nerves to help ease pain. You would try ONS first with a battery pack worn outside the body to see if it helps relieve pain before you get one inserted permanently. It has shown promise in treating some migraines and mixed results in preventing them.

Who Might Benefit

The FDA says neuromodulation devices that can be used outside the body pose very little chance of doing harm. They can be good choices if you don’t want to take migraine drugs for any reason. That can include if you:

  • Have other health issues
  • Can’t tolerate certain medication
  • Have concerns about side effects, like medication overuse headache
  • Find it hard to remember to take meds

The devices, especially TENS and TMS, sometimes can make you dizzy, sleepy, and uncomfortable. Neuromodulation may not be an option for children or if you’re pregnant or wear a pacemaker. Talk to your doctor about whether it’s the right treatment for you.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on May 16, 2018

Sources

SOURCES:

National Institute of Neurological Disorders and Stroke: “Migraine Information Page.”

American Migraine Foundation: “Understanding Migraine: Spotlight On: Neuromodulation Devices for Headache,” “Neuromodulation for Migraine Treatment,” “Sphenopalatine Ganglion Blocks in Headache Disorders,” “Understanding Migraine Stimulators and Headache,” “Nerve Stimulation for Chronic Migraine.”

Medscape: “Vagus Nerve Anatomy,” “Hope For ‘Suicide Headache,' ” “Occipital Nerve Stimulation.”

National Institute of Mental Health: “Brain Stimulation Therapies.”

FDA: “Treating Migraines: More Ways to Fight the Pain.”

Headache: “Sphenopalatine Ganglion (SPG): Stimulation Mechanism, Safety, and Efficacy.”

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