Migraine headaches: Could nerve stimulation help?

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

This would possibly look like an unlikely approach 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, slender (constrict) and open up (dilate) often, all through the day. That’s regular, and it varies relying on the scenario. Sleep, physique temperature, bodily exercise, and plenty of different elements have an effect on this exercise of blood vessels. Not way back, typical knowledge held that migraines have been attributable to an exaggeration of this regular constriction and dilation of blood vessels. Consultants thought {that a} set off — like sure meals, stress, or a bunch of different elements — made blood vessels supplying pain-sensitive elements of the mind instantly constrict for a short time after which dilate, earlier than returning to regular. We all know that comparable blood vessel adjustments happen in different circumstances comparable to Raynaud’s illness, so this was an interesting concept to clarify migraine signs.

If migraines have been attributable to exaggerated blood vessel constriction and dilation in some individuals, that would clarify why migraines are so widespread, momentary, and never related to any everlasting harm to the mind or different elements of the physique. Nonetheless, this concept is now thought-about mistaken.

The present concept of migraine

Present proof (as described on this evaluate) 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 elements of the mind, the discharge of chemical messengers, and adjustments within the sensitivity of nerves that carry ache indicators. Among the many nerves concerned are branches of the trigeminal nerve. This nerve supplies sensation to areas of the face, and controls muscular tissues that permit us to chunk or chew. It’s additionally related to the pain-sensitive lining of the mind.

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

What about nerve stimulation for migraines?

Lately, 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 gadget, the Cefaly Twin, has been out there by prescription to forestall migraine complications since 2014. It was simply cleared as an over-the-counter gadget to forestall and deal with migraine complications. Clearance differs from FDA approval for effectiveness and security for medicine and lifesaving expertise like defibrillators; it permits medical gadget makers to market a product as a result of the FDA considers it protected and much like different legally marketed merchandise.

The proof supporting nerve stimulation to forestall or deal with migraine consists of the next:

  • A examine revealed in 2013 enrolled 67 individuals with migraines and in contrast electrical stimulation to sham stimulation for 20 minutes every day as a approach to forestall complications. Over three months, fewer complications and a diminished want for migraine remedy have 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 forestall migraine, simply over half reported satisfaction with the gadget and a willingness to purchase it.
  • A 2019 examine randomly assigned 106 individuals with an energetic 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 practically 60% whereas these within the sham group had solely 30% ache discount.

What about downsides?

None of those research reported severe uncomfortable side effects associated to electrical stimulation. Whereas a tingling sensation on the website of stimulation was widespread, few perceived it as painful or bothersome sufficient to cease therapy.

Price is a consideration. The gadget’s maker at present lists its normal worth as $499, and states that it isn’t lined by medical insurance. It does include a 60-day money-back assure, which may assist customers resolve if it’s definitely worth the worth.

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

The underside line

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

The latest motion by the FDA to make the Cefaly Twin out there and not using a prescription ought to make it extra accessible. And, by any measure, a modestly efficient, drug-free approach to deal with migraine is a optimistic growth. Hopefully, future research of this gadget will make clear who’s most certainly to learn by utilizing it. However we’d like even higher choices. Advances in our understanding of how migraines develop and ongoing analysis ought to present them.

Comply with me on Twitter @RobShmerling

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