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 enhance or suppress the activity of the nervous system. Research has found this technology may be effective in reducing migraine attacks and cluster headaches. Learn more about neuromodulation works and who should use this alternative treatment option.

How neuromodulation works

Neuromodulation works via a device that uses electrical currents or magnets to modulate signaling 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 rationale is that they’re modulating 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 called 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 the FDA has approved for headache. The agency labels each of them as “minimal risk.” This means there are no known or expected significant side effects to occur with 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. “The currently available drug treatments for migraine and cluster have the potential for side effects that are prohibitive for some patients,” Dr. Halker Singh says, citing how difficult it can be for some patients to take pills consistently.

“If you had a device that could terminate 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, or before you came in every three months to get Botox?”

While these new treatments are not yet common, Dr. Tepper hopes that changes. “At this juncture, a lot of specialists who take care of headaches have no experience with these treatments at all because they came out of the pain area. But that doesn’t mean the use of these devices is very hard—it’s not. And that doesn’t mean they are not effective—they are,” he said.

While the technology has proven to be effective for some with migraine, neuromodulation may be cost-prohibitive for many patients. “We need to develop [neuromodulation devices], but we also need to make them accessible to patients,” Dr. Halker said. Making these devices more accessible will not just provide more treatment options for people with migraine. It will also incentivize researchers and manufacturers to develop more neuromodulation devices as an alternative to pharmacological medications.

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.