How to Explain Neuromodulation for Migraine to Your Patients 

Neuromodulation devices treat chronic pain by stimulating or inhibiting neural activity, via electrical or mechanical means, and can be a life-changing treatment for patients who experience chronic migraine.  

The technology may help manage migraine-related head pain and other symptoms alongside medication and other treatments, or as an alternative when medication has not been effective. It can also serve as a maintenance treatment to reduce the occurrence of migraine for those who want to rely less on rescue medication.  

Patients may have questions about the safety, efficacy and accessibility of neuromodulation devices, and may want to know how the technology acts on the nervous system to manage pain. The following responses to their most frequently asked questions can help you confidently inform patients about the benefits and function of neuromodulation.  

How does neuromodulation work? 

Neuromodulation most commonly uses gentle electrical pulses to stimulate the nerves, altering how your brain senses and processes pain. Communication between your nerves and brain is made possible by a series of electrochemical signals and connections. The stimulation from neuromodulation acts on these signals and connections. Neuromodulation technologies used to treat migraine at home are non-invasive, handheld, and many are available without a prescription.  

Is neuromodulation safe? 

Many studies have shown that neuromodulation is safe and effective. Neuromodulation has been used for decades to treat chronic pain, as well as movement and psychiatric disorders. However, supraorbital nerve stimulation may not be safe for people with recent brain or facial trauma, according to Migraine and Neuromodulation: A Literature Review.

Also, external trigeminal nerve stimulation should not be used by patients who have metallic or electronic devices implanted in the head, are suffering from pain of unknown origin, or have a cardiac pacemaker or an implanted or wearable defibrillator.

Is neuromodulation similar to electroconvulsive therapy? 

Electroconvulsive therapy is a form of neuromodulation for treating psychiatric disorders. It is not used for treating chronic pain or migraine. If a patient asks if ECT is similar to peripheral nerve stimulation for migraine, keep in mind that societal beliefs may contribute to their preexisting thoughts about neuromodulation, said Roy Hamilton, professor of neurology at the University of Pennsylvania.  

“… When people are asking me that question, what they’re actually asking me is a question about how dangerous they should perceive noninvasive stimulation as being,” Hamilton said. “They are asking me to compare it to ECT because their expectation is that ECT is quite dangerous, often misinformed by the stigma that’s been placed upon it in the media and entertainment.” 

Firstly, ECT is generally safe. Peripheral nerve stimulation for migraine, when delivered within specified parameters, is often safer than ECT. And the stimulation given by these technologies is “orders of magnitude less” than ECT, Hamilton notes.  

Does neuromodulation hurt? 

Neuromodulation should never be painful. The stimulation feels different for different people. Some describe it as a gentle prickling or tingly sensation, or even like a massage. If neuromodulation treatment hurts for any reason, advise the patient to stop their session. The cause may be incorrect contact with the skin or adhesion of the electrode; a cut or lesion on the skin; or a stimulation level set too high.

It’s essential for patients to understand that most neuromodulation devices for migraine allow them to control the intensity level. They should choose a level that’s comfortable and easy to tolerate for the length of the treatment session. Over time, their tolerance for the sensation should increase.

Is neuromodulation effective? 

Studies show that consistent use of neuromodulation can reduce the number of migraine days and reduce the intensity of migraine symptoms, such as head pain.  Neuromodulation devices can help prevent, reduce and stop headache attacks, often without the need for medication,” according to the American Migraine Foundation. “This can be valuable for people with migraine who face an elevated risk of medication overuse headache, but many people prefer non-drug treatment.”