Transcutanoues electrical nerve stimulation for migraine prevention

by Deena Kuruvilla, MD

Exciting medication and procedural approaches have been coming down the pipeline to prevent migraine. This month’s Journal of Pain highlights a study from China using transcutaneous occipital nerve stimulation for the prevention of migraine. Neuromodulation is defined as the alteration of nerve activity through the delivery of electrical stimulation to targeted sites of the body. There has been growing interest in non-medication approaches due to the sometimes intolerable side effect profile of drugs such as topiramate, a very commonly recommended migraine preventive medication.
This study is a randomized controlled trial of transcutaneous occipital nerve stimulation for the prevention of migraine. In this study, a total of one hundred and ten patients were divided into five treatment groups and the patients stayed in their group for one month of treatment. Groups A through C received stimulation at different frequencies with the device, group D received a sham stimulator, and group E was placed on topiramate, a prescription medication. Stimulation was delivered to the occipital nerves on both sides.
The study found a positive treatment response in all groups except for the sham group. There was not a significant difference in response between the different frequencies of the device and topiramate. In addition to this, headache days were reduced in all five groups with significant differences with higher frequency stimulation and topiramate compared with the sham group. Essentially, regardless of frequency, the stimulator was comparable to topiramate treatment.
Another transcutaneous stimulator device, namely the Cefaly device, has been FDA approved for the prevention of migraine. The device is worn on the forehead and specifically stimulates the supraorbital and supratrochlear nerves.
As these devices are further studied, it will be prudent to see more direct comparisons to medication for the prevention of migraine.

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