The Basics of Neuromodulation Therapy for Migraine

Neuromodulation, or neurostimulation, is “the alteration — or modulation — of nerve activity by delivering electrical or pharmaceutical agents directly to a target area,” as defined by the International Neuromodulation Society.¹ Simply put, it’s an intervention that changes the behavior of a nerve or the nervous system. Neuromodulation is most often used to relieve chronic pain. It also is used to treat many other neurological conditions such as Parkinson’s disease, epilepsy, essential tremor, depression, pelvic disorders and incontinence, and other disorders, including migraine.

How neuromodulation treats migraine

Various forms of ENS (electrical nerve stimulation) have been used to treat migraine. These include:

Occipital nerve stimulation (ONS)
Transcutaneous electrical nerve stimulation (TENS)
Vagus nerve stimulation (VNS)
External trigeminal nerve stimulation (TNS or eTNS)
Percutaneous electrical nerve stimulation (PENS)

The effect of ENS therapy on migraine pain is not fully understood and may differ among different forms of ENS.

One theory is that ENS is thought to modulate the activity of various chemical signals in the brain and nerves — including serotonin, gamma-aminobutyric acid (GABA), dopamine, and others — and consequently alter the processing of migraine pain signals.

Another theory suggests that some ENS modalities may reduce hyperexcitability in neural pathways which are primed to transmit pain signals, even in the absence of an active migraine attack.²

Some clinical studies also suggest that ENS therapies may also alter and improve metabolic functions of the brain associated with pain perception.³ As additional research emerges, we may find that ENS therapy treats migraine by a variety of mechanisms.

“These methods are almost free of harmful side effects and may be able to reduce the economic burden on those who suffer from migraines,” noted one systematic review of clinical studies of ENS for migraine.

Trigeminal nerve stimulation for migraine

For many years, scientists thought migraine was caused by the dilation and constriction of blood vessels in the head. That theory was later found to be incorrect. In 1979, researchers proposed an entirely different explanation: that the trigeminal nerve was the key pathway for migraine pain.⁴ This transformed the migraine field and led to the development of new trigeminal nerve migraine treatments.

The trigeminovascular system is widely considered by headache experts and migraine researchers to be the primary pathway, and one of the most consequential structures, in migraine pathophysiology. External trigeminal nerve stimulation (eTNS) is a safe and efficacious neuromodulation therapy — evidenced by several high-quality clinical studies — which directly targets and modulates the activity of the trigeminal nerve to both relieve active migraine attacks (acute therapy) and prevent future migraine attacks (preventative therapy).

An eTNS device connects to a self-adhesive electrode that’s placed on a migraine patient’s forehead. It sends tiny electrical impulses through the electrode and the skin of the forehead to stimulate the trigeminal nerve. This neurostimulation has both short-term and long-term benefits for people with migraine.

Common misconceptions about neuromodulation for migraine

Misconception: Neuromodulation is an invasive treatment that requires surgery.

Truth: While some neuromodulation devices are implanted, others are non-invasive, external devices.

Misconception: Neuromodulation is a new and experimental treatment.

Truth: Doctors have used neuromodulation to treat conditions since the 1960s, with proven results in various fields.

Misconception: Neurostimulation is painful.

Truth: Neurostimulation should never be painful. Most users adapt to the sensation over time.