Home Health Migraine complications: Might nerve stimulation assist? - Harvard Well being Weblog

Migraine complications: Might nerve stimulation assist? – Harvard Well being Weblog

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

This would possibly appear to be 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 sport changer? Hype? Or a therapy 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 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, typical knowledge held that migraines had been attributable to 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 elements of the mind instantly constrict for a short time after which dilate, earlier than returning to regular. We all know that related blood vessel adjustments happen in different circumstances equivalent to Raynaud’s disease, so this was an interesting concept to clarify migraine signs.

If migraines had been attributable to exaggerated blood vessel constriction and dilation in some folks, that might clarify why migraines are so widespread, momentary, and never related to any everlasting damage to the mind or different elements of the physique. Nonetheless, this concept is now thought-about incorrect.

The present concept of migraine

Present proof (as described in this review) 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 alerts. Among the many nerves concerned are branches of the trigeminal nerve. This nerve supplies sensation to areas of the face, and controls muscle mass that permit us to chew or chew. It’s additionally related 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 alerts. 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 forestall them. One such gadget, the Cefaly Dual, has been accessible by prescription to stop migraine complications since 2014. It was simply cleared as an over-the-counter gadget to stop and deal with migraine complications. Clearance differs from FDA approval for effectiveness and security for medicine and lifesaving know-how 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 stop or deal with migraine consists of the next:

  • A study published in 2013 enrolled 67 folks with migraines and in contrast electrical stimulation to sham stimulation for 20 minutes every day as a method to forestall complications. Over three months, fewer complications and a decreased want for migraine remedy had been noticed amongst these getting the actual therapy. Enchancment by not less than 50% was famous in 38% of research 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 stop migraine, simply over half reported satisfaction with the gadget and a willingness to purchase it.
  • A 2019 study randomly assigned 106 folks with an lively migraine headache to obtain electrical stimulation over the brow or a sham therapy (minimal electrical stimulation) for one hour. These receiving therapy 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 critical unintended effects associated to electrical stimulation. Whereas a tingling sensation on the web site of stimulation was widespread, few perceived it as painful or bothersome sufficient to cease therapy.

Value is a consideration. The gadget’s maker at the moment lists its commonplace worth as $499, and states that it isn’t lined by medical insurance. It does include a 60-day money-back assure, which may assist customers determine if it’s well worth the worth.

Lastly, there’s the time dedication. To forestall migraines, customers are suggested to use the gadget for 20 minutes every day. For therapy of acute headache, a 60-minute therapy is really helpful.

The underside line

This therapy has been round since not less than 2014 and is actually no treatment. So, electrical stimulation for migraine can hardly be thought-about a sport changer for many migraine victims. But it surely appears to me it’s not empty hype both. There may be affordable proof that it’s secure and not less than considerably efficient.

The current motion by the FDA to make the Cefaly Twin accessible and not using a prescription ought to make it extra accessible. And, by any measure, a modestly efficient, drug-free method to deal with migraine is a constructive growth. Hopefully, future research of this gadget will make clear who’s more than likely to profit through the use of 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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