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Migraine complications: May nerve stimulation assist?

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Are you one of many 20 million to 40 million folks within the US struggling with migraine complications? If that’s the case, right here’s information price noting: The FDA has simply authorized an over-the-counter nerve stimulation machine that delivers delicate electrical shocks to the brow as a technique to forestall or deal with migraine complications.

This may look like an unlikely technique to deal with migraines, so how did we get right here? And what’s the proof that it really works? Is that this a recreation changer? Hype? Or a therapy that falls someplace in between?

Our altering understanding of what causes migraines

Blood vessels all through the physique, together with these close to the mind, slim (constrict) and open up (dilate) recurrently, all through the day. That’s regular, and it varies relying on the scenario. Sleep, physique temperature, bodily exercise, and lots of different components have an effect on this exercise of blood vessels. Not way back, standard knowledge held that migraines have been on account of an exaggeration of this regular constriction and dilation of blood vessels. Consultants thought {that a} set off — like sure meals, stress, or a number of different components — made blood vessels supplying pain-sensitive elements of the mind all of the sudden constrict for a short time after which dilate, earlier than returning to regular. We all know that related blood vessel modifications happen in different circumstances reminiscent of Raynaud’s disease, so this was an interesting idea to elucidate migraine signs.

If migraines have been on account of exaggerated blood vessel constriction and dilation in some folks, that might clarify why migraines are so widespread, short-term, and never related to any everlasting damage to the mind or different elements of the physique. Nonetheless, this idea is now thought of fallacious.

The present idea of migraine

Present proof (as described in this review) means that migraine complications start with an irregular activation of cells within the nervous system that spreads throughout the mind. This results in irritation close to pain-sensitive elements of the mind, the discharge of chemical messengers, and modifications within the sensitivity of nerves that carry ache alerts. Among the many nerves concerned are branches of the trigeminal nerve. This nerve offers sensation to areas of the face, and controls muscle mass that enable us to chew or chew. It’s additionally related to the pain-sensitive lining of the mind.

This evolving understanding of potential causes of migraine complications has led to remedies that focus much less on blood vessel modifications and extra on methods to dam chemical messengers concerned in ache alerts. Triptan medicines, together with sumatriptan (Imitrex and others) and rizatriptan (Maxalt), are good examples.

What about nerve stimulation for migraines?

In recent times, research have demonstrated {that electrical} stimulation of branches of the trigeminal nerve over the brow can deal with migraine complications and even forestall them. One such machine, the Cefaly Dual, has been obtainable by prescription to forestall migraine complications since 2014. It was simply cleared as an over-the-counter machine to forestall and deal with migraine complications. Clearance differs from FDA approval for effectiveness and security for medication and lifesaving know-how like defibrillators; it permits medical machine makers to market a product as a result of the FDA considers it secure and much like different legally marketed merchandise.

The proof supporting nerve stimulation to forestall or deal with migraine consists of the next:

  • A study published in 2013 enrolled 67 folks with migraines and in contrast electrical stimulation to sham stimulation for 20 minutes every day as a technique to forestall complications. Over three months, fewer complications and a decreased want for migraine treatment have been noticed amongst these getting the true therapy. Enchancment by a minimum of 50% was famous in 38% of research topics, however in solely 12% of the sham group.
  • In a 2013 survey of greater than 2,300 folks utilizing electrical stimulation for 20 minutes every day for 2 months to forestall migraine, simply over half reported satisfaction with the machine and a willingness to purchase it.
  • A 2019 study randomly assigned 106 folks with an lively migraine headache to obtain electrical stimulation over the brow or a sham therapy (minimal electrical stimulation) for one hour. These receiving therapy reported ache discount of practically 60% whereas these within the sham group had solely 30% ache discount.

What about downsides?

None of those research reported critical unwanted side effects associated to electrical stimulation. Whereas a tingling sensation on the web site of stimulation was widespread, few perceived it as painful or bothersome sufficient to cease therapy.

Value is a consideration. The machine’s maker at present lists its normal worth as $499, and states that it isn’t lined by medical health insurance. It does include a 60-day money-back assure, which may assist customers determine if it’s well worth the worth.

Lastly, there’s the time dedication. To forestall migraines, customers are suggested to use the machine for 20 minutes every day. For therapy of acute headache, a 60-minute therapy is beneficial.

The underside line

This therapy has been round since a minimum of 2014 and is actually no remedy. So, electrical stimulation for migraine can hardly be thought of a recreation changer for many migraine victims. But it surely appears to me it’s not empty hype both. There’s cheap proof that it’s secure and a minimum of considerably efficient.

The current motion by the FDA to make the Cefaly Twin obtainable with out a prescription ought to make it extra accessible. And, by any measure, a modestly efficient, drug-free technique to deal with migraine is a optimistic improvement. Hopefully, future research of this machine will make clear who’s most probably to learn through the use of it. However we’d like even higher choices. Advances in our understanding of how migraines develop and ongoing analysis ought to present them.

Observe me on Twitter @RobShmerling

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