Neuromodulation for migraine treatment: An overview

How neuromodulation devices treat migraine and who should try these alternative therapies

Neuromodulation devices are advanced medical tools that can increase or decrease the activity of the nervous system. Research has found this technology may be effective in reducing migraine attacks and cluster headaches. While most of these devices require a prescription, the Federal Drug Administration (FDA) has approved one device to be sold over the counter.

Learn more about neuromodulation works and who should use this alternative treatment option.

How neuromodulation works

Neuromodulation is conducted with a device that uses electrical currents or magnets to adjust or change activity that occurs in the brain. Some of these devices can stop attacks that are already underway, while others are used preventatively. “They all work differently but the idea is that they’re changing the activity of the nerve pathways,” Dr. Rashmi Halker Singh, an assistant professor of neurology at the Mayo Clinic, has told the AMF. 

These devices are sometimes referred to as stimulators, although they often turn down brain activity rather than stimulate it. Neuromodulation devices can be electrical, temperature-altering, or magnetic. While they can be portable, some require surgical placement. Right now there are a few neuromodulation devices that have been approved by the FDA for headache and are no longer considered experimental. Each of them is labeled by the FDA as “minimal risk,” meaning no significant side effects are known or expected to occur with their use.

Who is best suited for this type of treatment?

Neuromodulation devices are attractive alternatives for people living with migraine. It’s hard to predict which patients will be most responsive to the devices, but it’s a reasonable option for those who have health issues or conditions that prevent them from taking medications or tolerability issues with medications, or who are worried about medication overuse headache.

“If you had a device that could stop a migraine attack without a drug, why wouldn’t you try that first, if it didn’t have side effects?” Dr. Stewart Tepper, professor of neurology at the Geisel School of Medicine at Dartmouth and director of the Dartmouth Headache Center told the AMF. “If you had a device that you could turn on twice a day, or three times a day, and prevent your migraine or cluster headaches without a drug, why wouldn’t you want to do that before you took a daily medication?”

While these new treatments are not yet commonly prescribed, Dr. Tepper hopes that changes. Dr. Tepper says these devices are easy for the patients to use, and can be very effective.

While the technology has proven to be effective for some with migraine, neuromodulation may be too expensive for many patients. “We need to develop [neuromodulation devices], but we also need to make them accessible to patients,” Dr. Halker said. The FDA’s recent approval of one neuromodulation device to be sold over-the-counter is a step in the right direction, and hopefully more options are to follow. Not only will making the devices more widely accessible provide more treatment options to people with migraine, it could also encourage researchers and manufacturers to develop more neuromodulation devices as an alternative to pharmacological medications.

Current neuromodulation treatments

There are currently four FDA-approved neuromodulation devices on the market. The Single Pulse Transcranial Magnetic Stimulator is a handheld device that works by generating a magnetic impulse that affects electrical signaling in the brain. It was first approved for the acute treatment of migraine with aura, and has recently been approved for the preventive treatment of migraine.

Update: In August 2020, the company manufacturing the Single Pulse Transcranial Magnetic Stimulator filed for bankruptcy. The device is currently not available to the public but we will keep you informed if that changes.

The Transcutaneous Vagus Nerve Stimulator is a noninvasive handheld tool that uses electrical stimulation to target the vagus nerve in the neck. It has been approved for the acute treatment of attacks in patients with episodic cluster headache as well as for the acute treatment of migraine pain. In 2021, this device was approved for use in adolescents aged 12-17.

The third type of device, the Transcutaneous Supraorbital Neurostimulator, also uses electrical stimulation to stimulate the supraorbital nerves. The device may be helpful in reducing migraine frequency, and it’s currently FDA-approved for both preventive and acute treatment of migraine.

In March 2021, a non-invasive multi-channel brain neuromodulation system was approved for the acute treatment for migraine. The device is worn as a headset and targets multiple nerves on the head. It has been shown to reduce pain and other migraine-related symptoms like sensitivity to light and sound.

Consulting with a headache specialist about your individual situation is the best way to decide whether to try a new treatment method like a neuromodulation device. Find a headache specialist close to you using our Find a Doctor search tool, or learn more about other treatment options in our resource library.