MIGRAINE HEADACHE -- treatment with various devices.

Timothy C. Hain, MD, Chicago IL. • Page last modified: June 2, 2021


Here we are going to comment on a set of devices proposed for migraine. Our perspective on this is basically -- be skeptical. Most if not all of these are either placebos or are just unreasonable. Or as they say, caveat emptor.

TENS -- Transcutaneous nerve stimulation

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). After all, we are dealing with a subjective disorder. Placebos work better if they involve devices.

There are also other bizzare devices (see below), involving shocking other parts of one's anatomy.

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 had only a few patients benefit from this device, although we have treated many 1000's of migraine patients.

The Cefaly device 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.

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: there's 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 devices to treat migraine: