Migraine complications: Might nerve stimulation assist? – Harvard Well being Weblog


Are you one of many 20 million to 40 million individuals within the US struggling with migraine complications? If that’s the case, right here’s information price noting: The FDA has simply authorized an over-the-counter nerve stimulation system that delivers gentle electrical shocks to the brow as a strategy to forestall or deal with migraine complications.

This would possibly look like an unlikely strategy to deal with migraines, so how did we get right here? And what’s the proof that it really works? Is that this a sport changer? Hype? Or a therapy that falls someplace in between?

Our altering understanding of what causes migraines

Blood vessels all through the physique, together with these close to the mind, slim (constrict) and open up (dilate) frequently, all through the day. That’s regular, and it varies relying on the state of affairs. Sleep, physique temperature, bodily exercise, and plenty of different components have an effect on this exercise of blood vessels. Not way back, typical knowledge held that migraines had been as a consequence of an exaggeration of this regular constriction and dilation of blood vessels. Specialists thought {that a} set off — like sure meals, stress, or a bunch of different components — made blood vessels supplying pain-sensitive components of the mind immediately constrict for a short time after which dilate, earlier than returning to regular. We all know that comparable blood vessel modifications happen in different situations similar to Raynaud’s illness, so this was an interesting concept to clarify migraine signs.

If migraines had been as a consequence of exaggerated blood vessel constriction and dilation in some individuals, that might clarify why migraines are so frequent, non permanent, and never related to any everlasting harm to the mind or different components of the physique. Nevertheless, this concept is now thought-about incorrect.

The present concept of migraine

Present proof (as described in this assessment) means that migraine complications start with an irregular activation of cells within the nervous system that spreads throughout the mind. This results in irritation close to pain-sensitive components of the mind, the discharge of chemical messengers, and modifications within the sensitivity of nerves that carry ache alerts. Among the many nerves concerned are branches of the trigeminal nerve. This nerve gives sensation to areas of the face, and controls muscle tissues that permit us to chew or chew. It’s additionally linked to the pain-sensitive lining of the mind.

This evolving understanding of potential causes of migraine complications has led to therapies that focus much less on blood vessel modifications and extra on methods to dam chemical messengers concerned in ache alerts. Triptan medicines, together with sumatriptan (Imitrex and others) and rizatriptan (Maxalt), are good examples.

What about nerve stimulation for migraines?

In recent times, research have demonstrated {that electrical} stimulation of branches of the trigeminal nerve over the brow can deal with migraine complications and even forestall them. One such system, the Cefaly Twin, has been accessible by prescription to stop migraine complications since 2014. It was simply cleared as an over-the-counter system to stop and deal with migraine complications. Clearance differs from FDA approval for effectiveness and security for medicine and lifesaving expertise like defibrillators; it permits medical system makers to market a product as a result of the FDA considers it secure and much like different legally marketed merchandise.

The proof supporting nerve stimulation to stop or deal with migraine contains the next:

  • A examine printed in 2013 enrolled 67 individuals with migraines and in contrast electrical stimulation to sham stimulation for 20 minutes every day as a strategy to forestall complications. Over three months, fewer complications and a decreased want for migraine remedy had been noticed amongst these getting the true therapy. Enchancment by no less than 50% was famous in 38% of examine topics, however in solely 12% of the sham group.
  • In a 2013 survey of greater than 2,300 individuals utilizing electrical stimulation for 20 minutes every day for 2 months to stop migraine, simply over half reported satisfaction with the system and a willingness to purchase it.
  • A 2019 examine randomly assigned 106 individuals with an lively migraine headache to obtain electrical stimulation over the brow or a sham therapy (minimal electrical stimulation) for one hour. These receiving therapy reported ache discount of almost 60% whereas these within the sham group had solely 30% ache discount.

What about downsides?

None of those research reported critical unwanted effects associated to electrical stimulation. Whereas a tingling sensation on the web site of stimulation was frequent, few perceived it as painful or bothersome sufficient to cease therapy.

Price is a consideration. The system’s maker presently lists its customary worth as $499, and states that it’s not coated by medical health insurance. It does include a 60-day money-back assure, which might assist customers determine if it’s definitely worth the worth.

Lastly, there’s the time dedication. To stop migraines, customers are suggested to use the system for 20 minutes every day. For therapy of acute headache, a 60-minute therapy is beneficial.

The underside line

This therapy has been round since no less than 2014 and is definitely no remedy. So, electrical stimulation for migraine can hardly be thought-about a sport changer for many migraine victims. However it appears to me it’s not empty hype both. There may be affordable proof that it’s secure and no less than considerably efficient.

The latest motion by the FDA to make the Cefaly Twin accessible with no prescription ought to make it extra accessible. And, by any measure, a modestly efficient, drug-free strategy to deal with migraine is a optimistic growth. Hopefully, future research of this system will make clear who’s probably to learn through the use of it. However we’d like even higher choices. Advances in our understanding of how migraines develop and ongoing analysis ought to present them.

Observe me on Twitter @RobShmerling

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