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MIGRAINE HEADACHE -- TENS TREATMENT

Timothy C. Hain, MD, Chicago IL. Page last modified: March 10, 2018

Introduction:

cefalyThere are numerous studies (see reference list for a few) that report improvement of migraine with transcutaneous stimulation.

The most recent device, Cefaly -- is a TENS unit recently FDA approved for migraine (2014). It stimulates the supraorbital nerve. There are many reports of migraine getting better from nerve stimulation (e.g. occipital nerve, sphenopalatine nerve, auricular nerve) as well as benefitting from nerve blocks (Magis, 2015; Ashkenazi and Young, 2005) and even infrared lasers -- i.e. heat (Allias et al, 2003). Puzzling, eh ? This may be a lot of wishful thinking (Ambrosini and Schoenen, 2016). Afterall, we are dealing with a subjective disorder.

The illustration on the left is from the cefaly web site. The double blind placebo controlled study in Belgium reported that it reduced the mean # of headache days. The therapeutic gain reported was 26%. This puts this device into the "mildly effective" category, as compared to migraine medications such as venlafaxine, verapamil, or topiramate which generally are effective in about half or more. We have not had a single patient ever benefit from this device.

It can be obtained with a prescription for $295. As a general rule, health insurance is slow to pay for "durable medical devices", such as this one. In other words, this is a $295"out of pocket" expense. A review of this device can be found here.

The principal of the Cefaly device is stimulation of the supraorbital nerves. But why would someone want to do this ? If your head is hurting, why shock it with more electricity ?

There are cheaper TENS units that are not as "cool" looking that can be adapted for the same purpose, and rented rather than purchased. This cuts the "out of pocket" cost down immensely. We think this is a logical way to proceed when trying out this treatment, but we don't see any reason for someone to try this in any case.

As a general comment, it is hard to see how shocking someone, anywhere on their body, would be likely to reduce their headache. Create a headache -- sure. I suppose one might argue that acupuncture reduces pain - -but these things don't seem to be acupuncture.

Regarding the numerous other devices have been suggested - -these all go under the general category of "Neuromodulation". Some of them use magnetic pulses instead of electrical pulses. All of these seem to us to be placebos. As PT Barnum supposedly said: theres a "sucker born every minute". Harsh perhaps ? Well anyway, lets look at a few of these. We are paraphrasing from the Tepper/Tepper article from 2018.

References for TENS and other electrical treatments of migraine:

 

Copyright March 10, 2018 , Timothy C. Hain, M.D. All rights reserved. Last saved on March 10, 2018