Why neuromodulation for migraine works — and what researchers still want to learn
Implantable or wearable neuromodulation devices work by either stimulating or inhibiting neural activity, beneficially altering the way nerves carry information throughout the nervous system. The result for people with migraine is decreased pain and better function and quality of life.
Neuromodulation also varies by the area of the nervous system targeted and mechanism of action. Studies show that neuromodulation lessens migraine pain intensity and reduces monthly migraine days and medication use.
Why neuromodulation is an effective therapy for migraine
Scientists are researching the mechanisms through which neuromodulation relieves and reduces migraine. Current research points to multiple factors that may explain the efficacy of these technologies in treating migraine.
“The trigeminal nerve is involved in attacks in almost all people with migraine,” according to the Association of Migraine Disorders. The trigeminal nerve has an essential role in motor control of the jaw and sends signals to the brain that enable the face to feel sensations of touch, temperature and pain. But these signals go haywire in people with migraine.
Most people with migraine have hypersensitive nervous systems, and triggers such as temperature changes, specific foods and chronic stress can activate nerve endings that easily register pain. These nerve endings then transmit distress signals to the brain via the trigeminal nerve system.
Certain forms of neuromodulation can reduce hyperactivation of the trigeminal system, which may end or prevent a migraine attack. The nerve fibers that carry pain signals to the brain may also be suppressed by trigeminal stimulation.
Neuromodulation may also work positively on an electrophysiological phenomenon called cortical spreading depression, which commonly occurs before migraines with aura — a prodrome for many migraine sufferers.
Cortical spreading depression is a period of excitation in cortical neurons, nerve cells in the cerebral cortex, followed by inactivity. Trigeminal stimulation is shown to inhibit the start, stop action of cortical spreading.
Scientists are still researching the role of cortical spreading in migraine with aura and its response to trigeminal stimulation. And more areas within the cortex are being researched as potential targets for neuromodulation.
What are the different types of neuromodulation for migraine?
External Trigeminal Nerve Stimulation (eTNS)
External trigeminal nerve stimulation is one form of electrical neuromodulation. CEFALY, a non-invasive, wearable neuromodulation device optimized for migraine relief and prevention, is an accessible solution for patients who suffer from chronic migraine. CEFALY targets migraine by stimulating the trigeminal nerve, the largest cranial nerve, via electrical impulses.
Remote Electrical Neuromodulation (REN)
Applied to the upper arm to stimulate peripheral nerves, remote electrical neuromodulation devices (such as NerivioⓇ) use conditioned pain modulation to treat migraine attacks. This stimulation of the peripheral nerves triggers the release of neurotransmitters that aid in pain inhibition.
Transcranial Magnetic Stimulation (TMS)
Transcranial magnetic stimulation uses magnetic field pulses to stimulate the prefrontal cortex through the scalp. These neuromodulators have been used extensively for treating depression and other mental health disorders. Recent studies show they may be effective for alleviating migraine pain and reducing migraine occurrence.
SAVI Dual™ is an FDA-cleared external TMS device that treats migraine by delivering a single magnetic pulse to the back of the head to regulate neuronal hyperactivity related to migraine.
Non-invasive vagus nerve stimulation (VNS)
The vagus nerve has a role in regulating autonomic functions such as digestion and heart rate. Stimulating the vagus nerve may dull or block pain signals in the brain.
gammaCore™ is a hand-held, non-invasive neuromodulator that delivers electrical impulses to the vagus nerve via the neck.
