The Benefits of Neuromodulation for Veterans with Migraine Disorder

Medically reviewed by Dr. Michael Johnson.

Migraine and other headache disorders represent a substantial and underrecognized health burden among U.S. veterans. In a cross-sectional study of over 490,000 U.S. military veterans, migraine prevalence was reported in 8.2% of men and a striking 30.1% of women—figures that significantly exceed those observed in the general U.S. population (6% of men and 17% of women, respectively). These findings reinforce earlier research indicating that military service, particularly among those with combat deployments, is associated with a markedly increased risk for migraine disorders.

Veterans with migraine commonly have coexisting conditions such as post-traumatic stress disorder, anxiety, depression, traumatic brain injury, and other chronic medical illnesses. These comorbidities often require targeted pharmacologic treatment, which can compromise the tolerability of migraine medications and increase the risk of adverse effects and drug-drug interactions.

Migraine in veterans is associated with functional impairment, including reduced ability to fulfill occupational duties. According to the cross-sectional study, “Veterans with migraine reported worse general health, higher levels of pain, increased pain interference with work, a higher likelihood of psychiatric and neurological health conditions, and greater lifetime opioid use.” Given the complexities of migraine management in the U.S. veteran population and limitations of medications, non-pharmacologic treatments—particularly neuromodulation—offer a promising avenue for reducing migraine burden while minimizing systemic adverse effects and drug interactions.

Causes of migraine in veterans

The number of veterans seeking treatment for migraine and other headache disorders has risen in recent years. According to the Veterans Administration, nearly 460,000 veterans sought care in the VHA for a headache disorder in 2022 (the most recent year for which data is available). From 2008 to 2022, the number of veterans using VA Medical Centers for headache care increased by 122%.

What might account for increased migraine and headache prevalence among veterans?

Deployment to recent conflict zones appears to be a significant risk factor. U.S. veterans who served in Iraq and Afghanistan exhibit higher rates of migraine and other headache disorders compared to the general population. Migraine prevalence has been estimated to be as high as 36% in veterans of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF).

Traumatic brain injury (TBI), concussions, and cervical injuries are well-established risk factors for headache disorders and have been strongly linked to migraine among veterans deployed to Iraq and Afghanistan. Studies indicate that veterans from these conflicts are diagnosed with TBI and related injuries at higher rates than those who served in earlier wars.

Burn pit exposure—specifically living near burn pits and having burn pit duties during deployment—was associated with a 93% increase in self-reported severe headache or migraine and a 56% higher likelihood of receiving a clinician-diagnosed headache disorder.

High rates of comorbid conditions such as PTSD, anxiety, depression, and traumatic brain injury, all of which are associated with increased migraine frequency and severity.

Migraine treatment for veterans at the Headache Centers of Excellence

In 2018, the Veterans Health Administration established the Headache Centers of Excellence in response to the increasing incidence of headache disorders in combat veterans.

At 19 comprehensive centers nationwide, specialists across multiple disciplines partner to deliver high-quality care for veterans living with migraine, cluster headache, headache associated with TBI, and other conditions.

Clinicians at the Headache Centers of Excellence take a comprehensive, individualized approach to migraine management. Treatment plans often incorporate both pharmacological and non-pharmacological strategies, which may include cognitive-behavioral therapy, chiropractic care, nerve blocks, botulinum toxin injections, acupuncture, and the use of neuromodulation devices.

Neuromodulation: a first-line or adjunct treatment for migraine in veterans

Managing migraine in veterans with polytrauma, traumatic brain injury (TBI), and multiple comorbidities poses unique clinical challenges.

Key considerations in this population include:

Increased risk of drug-drug interactions, particularly in veterans receiving pharmacologic treatment for coexisting medical or psychiatric conditions.
Medical contraindications to standard migraine therapies, such as the use of triptans in individuals with a history of stroke or myocardial infarction.
Reduced efficacy of certain migraine medications in veterans with chronic migraine or post-traumatic headache.
Potential for medication overuse headache and systemic side effects from frequent or prolonged use of acute migraine treatments.
Adverse effects of commonly prescribed therapies, including nausea, dizziness, sedation, fatigue, cognitive impairment, and mood disturbances.

These complexities underscore the need for individualized, multimodal treatment approaches—often incorporating nonpharmacologic strategies such as neuromodulation—to improve outcomes while minimizing treatment-related risks.

Neuromodulation devices manage chronic pain by targeting specific neural pathways through electrical, magnetic, or mechanical stimulation. Currently, five FDA-cleared neuromodulation devices utilize these mechanisms to alleviate migraine headaches and associated symptoms, including photophobia, phonophobia, and nausea.

One of the most notable advantages of neuromodulation devices for migraine management is their favorable safety profile. Migraine neuromodulation devices are not associated with serious adverse effects, and any side effects that do occur are typically mild, self-limited, and reversible upon discontinuation of device use. This makes neuromodulation a valuable addition to the therapeutic toolkit for providers treating veterans, whether used as a standalone intervention or in conjunction with pharmacologic therapies.

Neuromodulation devices for migraine that are available for veterans through the VA

Dr. Jason J. Sico, National Director of the Headache Centers of Excellence Program at the U.S. Department of Veterans Affairs, emphasizes the importance of accessible, evidence-based treatments for veterans living with migraine and other headache disorders. “It is extremely important to Veterans living with migraine and other headache diseases to have access to effective, evidence-based treatments,” Sico says. “Often, Veterans share with me that they prefer non-medication treatment options. One such option includes neuromodulation, or headache devices.”

The U.S. Department of Veterans Affairs provides coverage for neuromodulation treatments for migraine based on their demonstrated clinical efficacy. Currently, four FDA-cleared neuromodulation devices with robust evidence supporting their use for migraine relief and/or prevention are included under VA benefits:

CEFALY^Ⓡ employs external trigeminal nerve stimulation (eTNS) via an adhesive electrode placed on the forehead. It modulates activity in the trigeminal nerve, a key pathway implicated in migraine pathophysiology.
gammaCore™ is a non-invasive vagus nerve stimulator (nVNS) applied to the neck. It activates the vagus nerve to help suppress migraine-related pain signaling.
The eNeura^Ⓡ SAVI Dual device utilizes single-pulse transcranial magnetic stimulation (sTMS), delivering magnetic pulses to modulate cortical activity and interrupt pain transmission pathways between the cortex and deeper brain structures.
Nerivio^Ⓡ offers a remote electrical neuromodulation (REN) device worn on the upper arm. It stimulates peripheral nerves to engage descending pain inhibition pathways, thereby blocking migraine pain signals.