Remote Neuromodulation May Be Superior to Acute Medications for Migraine

  • Headache
  • Migraine
  • Neuromodulation

In a study published in The Journal of Headache and Pain remote electric neuromodulation (REN) for acute migraine treatment with the Nerivio device (Theranica; Netanya, Israel) was superior to acute treatment with medications. At 2 hours posttreatment with REN, pain relief was achieved by 66.7% of participants compared with 52.5% of people who took pharmacologic acute treatments (P < .05). This suggests that REN may be more effective than pharmacologic agents for acute migraine treatment and could be considered as first-line therapy.

Both treatments were similarly effective for generating freedom from pain after 2 hours. demonstrating noninferiority of REN compared with acute pharmacologic treatments and its nondependency on preventive medication use.

"REN is an exciting new pain relief option for migraine sufferers," said Alan M. Rapoport, MD, clinical professor of neurology, UCLA. "Additional options are needed, especially for those patients who experience challenges with efficacy, tolerability, or contraindications of medications, or medication overuse headaches. Providing the migraine patient community with safe and effective alternatives is important, and REN looks very promising."

In this double-blind study, 99 participants completed a 2 to 4 weeks run-in phase during which they treated their migraine with their usual preferred drug. The agents used included various triptans, acetominophin, and nonsteroidal anti-inflammatory steroids (NSAIDs). Freedom from pain and pain relief were tracked in electronic migraine diaries. After the run-in period, individuals were randomly assigned to receive REN or sham neuromodulation. Efficacy of REN in individuals who treated at least 1 migraine with the active device was compared to efficacy of usual pharmacologic treatment using a within-subject design.

The REN device is applied on the upper arm for 45 minutes at the start of a migraine attack and induces conditioned pain modulation, a descending endogenous analgesic mechanism that inhibits pain.      

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