Migraine complications: May nerve stimulation assist?

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

This would possibly look like an unlikely method to deal with migraines, so how did we get right here? And what’s the proof that it really works? Is that this a recreation changer? Hype? Or a remedy 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 elements have an effect on this exercise of blood vessels. Not way back, standard knowledge held that migraines have been resulting from an exaggeration of this regular constriction and dilation of blood vessels. Consultants thought {that a} set off — like sure meals, stress, or a number of different elements — 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 related blood vessel modifications happen in different circumstances similar to Raynaud’s illness, so this was an interesting concept to clarify migraine signs.

If migraines have been resulting from exaggerated blood vessel constriction and dilation in some folks, that would clarify why migraines are so frequent, momentary, and never related to any everlasting damage to the mind or different components of the physique. Nevertheless, this concept is now thought of unsuitable.

The present concept of migraine

Present proof (as described on this evaluation) 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 indicators. Among the many nerves concerned are branches of the trigeminal nerve. This nerve gives sensation to areas of the face, and controls muscular tissues that enable 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 indicators. 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 stop them. One such machine, the Cefaly Twin, has been accessible by prescription to forestall migraine complications since 2014. It was simply cleared as an over-the-counter machine to forestall and deal with migraine complications. Clearance differs from FDA approval for effectiveness and security for medication and lifesaving expertise like defibrillators; it permits medical machine makers to market a product as a result of the FDA considers it secure and just like different legally marketed merchandise.

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

  • A examine revealed in 2013 enrolled 67 folks with migraines and in contrast electrical stimulation to sham stimulation for 20 minutes every day as a method to stop complications. Over three months, fewer complications and a decreased want for migraine treatment have been noticed amongst these getting the true remedy. Enchancment by a minimum of 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 folks utilizing electrical stimulation for 20 minutes every day for 2 months to forestall migraine, simply over half reported satisfaction with the machine and a willingness to purchase it.
  • A 2019 examine randomly assigned 106 folks with an energetic migraine headache to obtain electrical stimulation over the brow or a sham remedy (minimal electrical stimulation) for one hour. These receiving remedy 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 unintended 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 remedy.

Price is a consideration. The machine’s maker presently lists its commonplace value as $499, and states that it isn’t coated by medical insurance. It does include a 60-day money-back assure, which might assist customers resolve if it’s definitely worth the value.

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

The underside line

This remedy has been round since a minimum of 2014 and is definitely no treatment. So, electrical stimulation for migraine can hardly be thought of a recreation changer for many migraine victims. But it surely appears to me it’s not empty hype both. There’s affordable proof that it’s secure and a minimum of considerably efficient.

The current 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 method to deal with migraine is a optimistic improvement. Hopefully, future research of this machine will make clear who’s almost certainly to profit by utilizing it. However we want 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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