Neuromodulation for Headache
What is neuromodulation?
Neuromodulation is the use of devices that emit electrical or magnetic fields to help stop headache symptoms. At Barrow, we use two types of neuromodulation devices for the treatment of headaches:
- Cefaly is a device cleared by the Food and Drug Administration (FDA) for the prevention of migraine headaches. Through an adhesive electrode that is placed on the forehead, Cefaly generates precise micro-impulses to stimulate the trigeminal nerve, which is involved in most migraine headaches. Stimulation of the trigeminal nerve using Cefaly is thought to suppress activity in the fibers within that nerve that carry pain signals to the brain. Cefaly is available without a prescription.
- Transcranial magnetic stimulation (TMS) is a noninvasive method of brain stimulation cleared by the FDA that uses electromagnetic fields to stimulate groups of nerves within 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.
What is neuromodulation for headache used for?
Cefaly is used to reduce migraine occurrences. It is recommended that you use Cefaly once a day for 20 minutes to prevent migraine attacks. The device allows you to increase the intensity of the impulses so that your sessions become more and more effective as you build tolerance.
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.
Am I a good candidate for neuromodulation for headache?
Cefaly is approved for use in people 18 years and older. It is not recommended if you have a metallic or electronic device implanted in your head, if you are suffering from pain of an unknown origin, or if you have a cardiac pacemaker or an implanted or a wearable defibrillator.
For the best chance of improving your symptoms, you will need to use Cefaly for one 20-minute session every day. Side effects from the use of Cefaly are rare. They can include intolerance of the feeling of the device on the forehead, allergic skin reaction to the electrode, fatigue during and after the session, and headache after the session.
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
You should not receive TMS if you have a pacemaker, shunt, or spinal cord stimulator.