Woman in pain from migraine headache

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 accredited an over-the-counter nerve stimulation gadget that delivers gentle electrical shocks to the brow as a approach to stop or deal with migraine complications.

This would possibly look like an unlikely approach to deal with migraines, so how did we get right here? And what’s the proof that it really works? Is that this a sport 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, slender (constrict) and open up (dilate) usually, 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 had been as a consequence of an exaggeration of this regular constriction and dilation of blood vessels. Consultants thought {that a} set off — like sure meals, stress, or a bunch 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 comparable blood vessel adjustments happen in different situations resembling Raynaud’s illness, so this was an interesting concept to elucidate migraine signs.

If migraines had been as a consequence of exaggerated blood vessel constriction and dilation in some individuals, that might clarify why migraines are so frequent, non permanent, and never related to any everlasting damage to the mind or different components of the physique. Nonetheless, this concept is now thought of flawed.

The present concept of migraine

Present proof (as described on this overview) 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 adjustments within the sensitivity of nerves that carry ache alerts. Among the many nerves concerned are branches of the trigeminal nerve. This nerve gives sensation to areas of the face, and controls muscle groups that permit 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 remedies that focus much less on blood vessel adjustments and extra on methods to dam chemical messengers concerned in ache alerts. Triptan medicines, together with sumatriptan (Imitrex and others) and rizatriptan (Maxalt), are good examples.

What about nerve stimulation for migraines?

Lately, 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 gadget, the Cefaly Twin, has been out there by prescription to forestall migraine complications since 2014. It was simply cleared as an over-the-counter gadget to forestall and deal with migraine complications. Clearance differs from FDA approval for effectiveness and security for medicine and lifesaving expertise like defibrillators; it permits medical gadget 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 printed in 2013 enrolled 67 individuals with migraines and in contrast electrical stimulation to sham stimulation for 20 minutes every day as a approach to stop complications. Over three months, fewer complications and a decreased want for migraine remedy had 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 forestall migraine, simply over half reported satisfaction with the gadget and a willingness to purchase it.
  • A 2019 examine randomly assigned 106 individuals with an lively 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 severe unwanted 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.

Value is a consideration. The gadget’s maker presently lists its commonplace value as $499, and states that it isn’t coated by medical health insurance. It does include a 60-day money-back assure, which may 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 gadget for 20 minutes every day. For remedy of acute headache, a 60-minute remedy is really useful.

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 sport changer for many migraine victims. However it appears to me it’s not empty hype both. There may be cheap proof that it’s secure and at the very least considerably efficient.

The current motion by the FDA to make the Cefaly Twin out there with out a prescription ought to make it extra accessible. And, by any measure, a modestly efficient, drug-free approach to deal with migraine is a optimistic growth. Hopefully, future research of this gadget 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.

Comply with me on Twitter @RobShmerling

The publish Migraine complications: Might nerve stimulation assist? appeared first on Harvard Well being Weblog.


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