Neuromodulation Devices for the Treatment of Migraines
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Running head: NEUROMODULATION FOR MIGRAINES
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Neuromodulation for the Treatment of Migraines
Michelle S. Cerroni
Saint Joseph’s College of Maine
NEUROMODULATION FOR MIGRAINES
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Neuromodulation for the Treatment of Migraines
Migraines are one of the most common illnesses and can be highly debilitating to those
that suffer from them. “Migraine affects more than 10% of the general population and is one of
the most prevalent medical conditions in the world” (Yuan & Chuang, 2021). Until recently,
treatment options were primarily limited to pharmaceuticals that are often ineffective or have
intolerable side effects. Around the turn of the twenty-first century, neuromodulation devices,
which stimulate the nerves involved in migraines, were developed and proven as safe, effective
treatment modalities. “In the last two decades, noninvasive neuromodulation devices have
become an effective alternative to pharmacological treatment for migraine due to a better
mechanistic understanding of headache pathophysiology and burgeoning technological
advances” (Yuan & Chuang, 2021). Several FDA-approved devices are discussed in this paper.
One of the most common FDA-approved neuromodulation treatments for migraines is
TENS (transcutaneous electrical nerve stimulation) units. The idea of utilizing electricity to ease
pain is a familiar one. “TENS, in its earliest conceptual form, is believed to date back to
approximately 60 A.D. The Roman physician Scribonius Largus proposed symptomatic relief to
patients by having the patient be exposed and in contact with an ‘electric fish’ from the ocean”
(Teoli, D & An, J.). However, the TENS units as we know them, have only been around since the
1970s and “are credited to American neurosurgeon Dr. C. Norman Shealy” (Teoli, D & An, J.).
The first FDA-approved TENS unit for migraine prevention and treatment is Cefaly. “The
Cefaly device is an external trigeminal nerve stimulation device (e-TNS) that transcutaneously
excites the supratrochlear and supraorbital branches of the ophthalmic nerve (V1) via a bipolar
self-adhesive electrode (30 x 94 mm) applied to the forehead” (Urits et al., 2020). Research
studies comparing Cefaly to other migraine treatments have shown it to be a safe, effective
NEUROMODULATION FOR MIGRAINES
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option. Unlike pharmaceuticals, neuromodulation devices cannot lead to overdose, chemical
dependence, or systemic side effects. “Among tested devices, several are already approved for
clinical use, such as the TENS device, called Cefaly™, which is C.E. marked and FDA cleared.
Based on current evidence, it appears to be useful for preventive treatment and possibly acute
treatment” (Moisset et al., 2020).
Another class of neuromodulation devices is implanted in the skin and targets the vagus
or occipital nerves with smartphone integration. “The NEMOS device is a recently developed
neuromodulatory technique that applies a wireless, wearable, non-invasive device controlled by a
smartphone application, which stimulates the peripheral nerves of the upper arm. It is an
effective, well tolerated, and safe non-pharmacological method for acute treatment in CM
(chronic migraine)” (Szok et al., 2023).
Compared to typical pharmaceutical treatments for migraines, neuromodulation devices
provide a cost-effective alternative. Botox can cost over one-thousand dollars every three
months, depending on insurance coverage. “Cefaly is available OTC. It can be bought from their
website for $379” (Aungst, T, 2021). Some other neuromodulation devices can range up to a
couple of thousand dollars. However, when used with other therapies, these devices can limit
emergency services, which are costly to both the patient and the healthcare system. They can also
reduce the medication needed to control migraines, saving patients money.
As neuromodulation technology progresses, they are evolving from a therapeutic tool to a
method of obtaining previously hidden data within the human body, altering the course of
treatment. The treatments mentioned above have been open-loop systems. However, current and
emerging closed-loop systems react to biological stimuli and can provide valuable insight.
“Responsive, or closed-loop, neuromodulation systems adjust stimulation according to a
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NEUROMODULATION FOR MIGRAINES
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clinically relevant physiologic signal. Because some seizures are associated with acceleration in
heart rate, a heart rate sensor incorporated into some vagus nerve stimulation devices activates
stimulation when heart rate exceeds a predetermined threshold” (Dennison & Morrell, 2022).
Neuromodulation devices can help us learn more about the internal signals our body
provides, even before symptoms are seen. This data will provide invaluable insight into chronic
medical conditions, such as migraines, and help to produce more effective neuromodulation
treatments. “Many neuromodulation devices will be used as disease management platforms.
Patients and physicians will be empowered by device-provided objective neural biomarker data
to personalize device programming and track the clinical response, not only to neuromodulation,
but also to changes in behavior or in pharmacologic treatment” (Dennison & Morrell, 2022).
In conclusion, neuromodulation devices, as we know them, are a relatively new but
promising alternative treatment for migraines and other neurological conditions. Non-invasive,
FDA-approved devices, such as Cefaly and NEMOS, target nerves associated with migraines and
have demonstrated efficacy without the potential for side effects or overuse that pharmaceutical
options bring. These devices are either wearables or implants and even have become smartphone
integrated. They are cost-effective and less expensive than Botox, the primary migraine
treatment. Indirectly, they save money from emergency room visits and expensive prescription
drugs. Closed-loop devices provide crucial information about biomarkers associated with chronic
conditions that signal the device to deliver an electric impulse. These technologies are constantly
evolving and will provide ongoing education about these conditions and direct the future of
neuromodulation.
NEUROMODULATION FOR MIGRAINES
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References
Aungst, T., Pharm. D. (2021, November 4). 4 FDA-Cleared Devices That Can Treat Your
Migraines. GoodRx Health. Retrieved from
https:://www.goodrx.com/conditions/migraine/consumer-devices-for-migraine-treatment-
and-prevention
Denison, T., & Morrell, M. J. (2022). Neuromodulation in 2035: The Neurology Future
Forecasting Series.
Neurology
,
98
(2), 65–72.
https://doi.org/10.1212/WNL
.
0000000000013061
Moisset, X., Pereira, B., Ciampi de Andrade, D., Fontaine, D., Lantéri-Minet, M., & Mawet, J.
(2020). Neuromodulation techniques for acute and preventive migraine treatment: a
systematic review and meta-analysis of randomized controlled trials.
The journal of
headache and pain
,
21
(1), 142.
https://doi.org/10.1186/s10194-020-01204-4
Szok, D., Csáti, A., Vécsei, L., & Tajti, J. (2023). Chronic Migraine as a Primary Chronic Pain
Syndrome and Recommended Prophylactic Therapeutic Options: A Literature
Review.
Life
. 13(3):665. https://doi.org/10.3390/life13030665
Teoli D, An J. Transcutaneous Electrical Nerve Stimulation. ( 2022, Oct
31). StatPearls Publishing.
Retrieved from:
https://www.ncbi.nlm.nih.gov/books/NBK537188/
Urits, I., Schwartz, R., Smoots, D., Koop, L., Veeravelli, S., Orhurhu, V., Cornett, M.,
Manchikanti, L., Kaye, A. D., Imani, F., Varrassi, G., & Viswanath, O. (2020).
Peripheral Neuromodulation for the Management of Headache.
Anesthesiology and pain medicine
,
10
(6), e110515.
https://doi.org/10.5812/aapm.110515
NEUROMODULATION FOR MIGRAINES
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Yuan, H., & Chuang, T. Y. (2021). Update of Neuromodulation in Chronic Migraine.
Current
pain and headache reports
,
25
(11), 71. https://doi.org/10.1007/s11916-021-00988-7
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