Neuromodulation for Headache

Neuromodulation Overview

Neuromodulation is the use of devices that emit electrical or magnetic fields to help treat headache symptoms. Some types of neuromodulation for headache work to prevent headaches, whereas some work to treat a headache once it occurs. Several different options exist for the treatment of headache via neuromodulation. 

Neuromodulation is often considered for patients with headache who are either looking for alternatives to traditional medications or procedures used for headache treatment or for patients looking to add another option to their current treatment regimen.

Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation (TMS) is a noninvasive method of brain stimulation cleared by the FDA that uses electromagnetic impulses to regulate signals in the brain. The pulses are generated by a plastic-insulated metal coil that is placed over the scalp. They can be delivered one at a time or in rapid succession. When the pulses are delivered in rapid succession, the treatment is known as repetitive TMS (rTMS). A prescription from your physician is required for a TMS device. 

Recent studies show that TMS Therapy may be effective in treating and preventing migraines. Migraines occur when bursts of activity are followed by a period of inactivity called cortical spreading depression in the nerves that connect the brain to the face and other parts of the head. Because the brain works through the conduction of electrical impulses, intentionally introducing mild electrical fields to the brain through TMS may modulate the excitability of neurons and thereby reduce cortical spreading depression. Repetitive TMS may help prevent migraines by producing longer-lasting changes in brain activity.

You may be a good candidate for transcranial magnetic stimulation if you have migraines that do not respond to medication.

Side effects of TMS are generally mild to moderate and improve shortly after treatment. They may include:

• Scalp discomfort at the site of stimulation
• Tingling, spasms, or twitching of facial muscles
• Lightheadedness

You should not receive TMS if you have a pacemaker, shunt, or spinal cord stimulator.

gammaCore

gammaCore is a noninvasive vagal nerve stimulator that can be used for acute treatment of migraine and cluster headaches. There are also dosing regimens for the prevention of migraine and cluster headaches provided with the gammaCore device. Patients with hemicrania continua and paroxysmal hemicrania may see benefit with gammaCore as well.

Treatment duration tends to be around four to six minutes and can be repeated throughout the day if additional attacks occur. 

Possible side effects include skin irritation, muscle twitching, pain, dizziness. 

It is meant to be used in patients ages 12 and older. It should not be used in pregnant women or in patients with carotid atherosclerosis, congenital cardiac issues, prior vagal nerve surgeries, high or low blood pressure or heart rate, or an implantable electric stimulation device or an implanted metallic device.

Relivion

Relivion is a multi-channel brain neuromodulation system that targets branches of the occipital and trigeminal nerves with electrical stimulation to treat migraine headache pain. It is a prescription device indicated for the acute treatment of migraine pain in patients at least 18 years of age. 

You should not use Relivion if you have an active implantable medical device (e.g., pacemaker, vagal nerve stimulator, spinal cord stimulator) or any other implanted metal device. 

Side effects may include scalp numbness, tingling sensation, pain, skin irritation, sleepiness, dizziness, and headache. 

Nerivio

Nerivio uses conditioned pain modulation via transcutaneous electrical nerve stimulation to treat migraine by sending weak electrical impulses to skin. It is designed to treat migraine headaches when they occur. 

Nerivio is meant to be used for patients with episodic migraine and who are at least 18 years of age. You should not use Nerivio if you have an active implantable medical device (e.g., pacemaker, vagal nerve stimulator, spinal cord stimulator). It is meant to be used for 45 minutes and is thought to be most effective if used within one hour of the onset of a migraine. 

It is important to keep in mind that the details described above are not exhaustive of the indications, instructions, and contraindications to each of the neuromodulation devices. Prior to using one of these devices, every patient should review the details with their physician and their individual medical and surgical histories should be taken into account.