Migraine complications: Might nerve stimulation assist?

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 value noting: The FDA has simply permitted an over-the-counter nerve stimulation machine that delivers delicate electrical shocks to the brow as a option to stop or deal with migraine complications.

This may look like an unlikely option 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) often, all through the day. That’s regular, and it varies relying on the scenario. Sleep, physique temperature, bodily exercise, and lots of different elements have an effect on this exercise of blood vessels. Not way back, typical knowledge held that migraines have been on account 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 elements — made blood vessels supplying pain-sensitive elements of the mind abruptly constrict for a short time after which dilate, earlier than returning to regular. We all know that related blood vessel adjustments happen in different situations akin to Raynaud’s illness, so this was an interesting concept to elucidate migraine signs.

If migraines have been on account of exaggerated blood vessel constriction and dilation in some individuals, that would clarify why migraines are so widespread, short-term, and never related to any everlasting damage to the mind or different elements of the physique. Nonetheless, this concept is now thought of unsuitable.

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 gives sensation to areas of the face, and controls muscular tissues that enable us to chunk 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 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?

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 obtainable by prescription to stop migraine complications since 2014. It was simply cleared as an over-the-counter machine 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 machine 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 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 option to stop complications. Over three months, fewer complications and a lowered want for migraine remedy have been noticed amongst these getting the true remedy. Enchancment by at the very least 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 machine 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 remedy (minimal electrical stimulation) for one hour. These receiving remedy 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 unwanted 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 remedy.

Price is a consideration. The machine’s maker at the moment lists its commonplace value 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 resolve if it’s well 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 at the very least 2014 and is definitely no treatment. So, electrical stimulation for migraine can hardly be thought of a recreation changer for many migraine victims. Nevertheless it appears to me it’s not empty hype both. There may be cheap proof that it’s protected and at the very least considerably efficient.

The current motion by the FDA to make the Cefaly Twin obtainable with out a prescription ought to make it extra accessible. And, by any measure, a modestly efficient, drug-free option to deal with migraine is a constructive growth. Hopefully, future research of this machine will make clear who’s more than likely to learn 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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