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Nerve Stimulation Devices for Chronic Migraine Treatment

Medically Reviewed by Melinda Ratini, DO, MS on February 15, 2022

If you get migraines, you know it can be hard to find relief. You and your doctor have lots of medicines to choose from, but they don’t all work for everyone. And most have side effects. Some drugs can even cause headaches if you use them too often. A treatment that may work to help stop, prevent, or reduce how often you have migraines -- when drugs don’t -- is called electrical nerve stimulation (ENS).

How Does Electrical Nerve Stimulation Work?

Doctors are learning more all the time about what causes migraines. One possibility is that they start with a problem with the pain-sensing nerves in the brain. Newer treatments are looking at ways to change brain activity to block pain signals.

With ENS, certain nerves are targeted with a harmless electrical current to try to shut down a migraine. The main nerves it’s used on are:

  • The trigeminal nerve in the forehead that controls movement and sensation in the face.
  • The vagus nerve that runs from the brain to the abdomen and controls breathing, heart rate, and digestion.
  • The occipital nerve covering the back of the scalp.

This kind of treatment is still in the early stages, although the technology is improving. The devices on the market are fairly pricey, and studies on their effectiveness are mixed. But they may be worth discussing with your doctor.

What Is Transcutaneous Supraorbital Nerve Stimulation?

You may hear this called e-TNS, or external trigeminal nerve stimulation. It works through the skin above your eyebrows on the trigeminal nerve in your forehead. The FDA cleared a device called Cefaly for sale without a prescription to both prevent and treat migraines.

To prevent a migraine, you put it on your forehead for 20 minutes every day. When you do get a migraine, you can put it on for up to an hour to treat the pain. You tap the device to control the strength of the electrical impulse.

  • Cefaly is available over the counter, without a prescription.
  • It’s approved for adults only.
  • Insurance doesn’t cover it. The list price is $379, and replacement electrode pads cost about $8 each.
  • You can’t use Cefaly if you have a pacemaker or metal or electronic devices in your head.

You may feel tingling while you use Cefaly. It can also cause sleepiness or a headache.

Research has found this type of treatment can be helpful. People using it have reported fewer migraine days and less pain.

The FDA recently cleared a similar device for migraine treatment called Relivion. It also works through the skin. But it wraps around your head to deliver electrical pulses to both the trigeminal nerve in your forehead and the occipital nerve in the back of your head. You put it on at the start of a migraine for up to an hour. And you can adjust the intensity.

  • Relivion is available by prescription.
  • It’s for adults only.
  • Check with your doctor about cost and insurance coverage.
  • You can’t use Relivion if you have a pacemaker or metal or electronic devices in your head, or if you’ve recently had a serious brain or facial injury.

You may feel tingling or numbness when you use it. And it may cause sleepiness or a headache.

In research the company presented to the FDA, people who used it had a great deal of relief of pain and other symptoms like nausea and sensitivity to light and sound.

What Is Noninvasive Vagus Nerve Stimulation?

This treatment also works through your skin. But it targets the vagus nerve in the sides of your neck. The FDA has cleared a device called gammaCore to prevent and treat migraines.

You hold it to the side of your neck for 2 minutes, wait a few seconds, then do it again.

To prevent migraines, you do that three times a day. When you have a migraine, you can use it when you feel pain, then again after 20 minutes. If you still have pain, you can use it again 2 hours later.

  • gammaCore is available by prescription.
  • It’s cleared for adults and children 12 and older.
  • gammaCore costs about $600 a month. The company offers a patient assistance program that lowers that by $100. Most insurance doesn’t cover it, but check your policy.
  • You can’t use gammaCore if you have a pacemaker or metal or electronic devices in your head or neck, and you shouldn’t use it at the same time as your cellphone or other portable electronics.

You may feel tingling while you use the device, and you may have muscle twitches or a headache.

Research has found vagus nerve stimulation may reduce migraine pain. It’s less clear whether it cuts the number of migraines you have.

What Is Remote Electrical Neuromodulation?

This treatment works on the idea that stimulating nerves in one part of the body will short-circuit the pain response in another part. The FDA has cleared a device called Nerivio. It’s a cuff you wrap around your upper arm that applies an electrical pulse to the nerves there. You use it at the start of migraine pain for up to 45 minutes. You can control it through a smartphone app.

  • Nerivio is available by prescription.
  • It’s cleared for adults and children 12 and older.
  • The list price for Nerivio is $600 for a device loaded with 12 treatments. But some insurance programs can bring that down.
  • You can’t use it if you have a pacemaker or other implanted metal or electronic device, or if you have epilepsy, heart failure, or serious heart or blood vessel disease.

You may feel tingling, numbness, pain, or twitching in your arm.

Many people who took part in several studies on Nerivio reported relief from their pain.

What Is Occipital Nerve Stimulation?

Another treatment researchers are looking at targets the occipital nerve in the back of the scalp. It’s a surgical procedure. Wires are implanted under the skin at the base of your skull, just above your neck. They’re attached to a small generator that’s sewn inside your body, usually under your collarbone or in your abdomen.

The FDA approved it to treat certain kinds of pain but not migraine. Still, doctors are using it off-label or experimentally for people who don’t respond to drug treatment. But there’s no standardized treatment of how long or how often to use it.

Many people taking part in studies had good pain relief and fewer migraine days.

Some feel a tingling or pulsing sensation when the implant is working. As with any surgery, there are risks like infection and pain. And the device may have to be removed.

Show Sources

SOURCES:

Cureus: “The Use of Electrical Nerve Stimulation to Treat Migraines: A Systematic Review.”

American Migraine Foundation: “Spotlight On: Medication Overuse Headache,” “Neuromodulation for migraine treatment: An overview.”

Harvard Health Publishing: “Migraine headaches: Could nerve stimulation help?”

UpToDate: “Acute treatment of migraine in adults.”

Neuromodulation: “Cervical Noninvasive Vagus Nerve Stimulation for Migraine and Cluster Headache: A Systematic Review and Meta-Analysis.”

Cefaly.com.

Cephalalgia: “Acute migraine therapy with external trigeminal neurostimulation (ACME): A randomized controlled trial.”

Neurology: “Migraine prevention with a supraorbital transcutaneous stimulator.”

The Journal of Headache and Pain: “Neuromodulation techniques for acute and preventive migraine treatment: a systematic review and meta-analysis of randomized controlled trials,” “Non-invasive vagus nerve stimulation for acute treatment of high-frequency and chronic migraine: an open-label study,” “Remote electrical neuromodulation (REN) in the acute treatment of migraine: a comparison with usual care and acute migraine medications.”

American Headache Society: “Noninvasive occipital and trigeminal neuromodulation technology cleared by FDA for the acute treatment of migraine.”

Relivion MG User Manual for Patients.

63rd Annual Scientific Meeting American Headache Society, June 3-6, 2021.

gammaCore.com.

U.S. Pharmacist: “gammaCore Noninvasive Vagus Nerve Stimulator.”

Instructions for Use for gammaCore Sapphire SLC.

Pain Reports: “Safety and efficacy of remote electrical neuromodulation for the acute treatment of chronic migraine: an open-label study.”

Nerivio.com.

Nerivio QuickStart Guide.

News release, Theranica.

BlueCross BlueShield of North Carolina: “Corporate Medical Policy: Occipital Nerve Stimulation.”

Mayo Clinic: “Occipital nerve stimulation: Effective migraine treatment?”

Pain and Therapy: “Occipital Nerve Stimulation in Chronic Migraine: The Relationship Between Perceived Sensory Quality, Perceived Sensory Location, and Clinical Efficacy—A Prospective, Observational, Non-Interventional Study.”

Pain Physician: “Occipital Nerve Stimulation for Refractory Chronic Migraine: Results of a Long-Term Prospective Study.”

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