What this new treatment option means for people with migraine
Neuromodulation devices are advanced medical tools that use currents or magnets to target the specific nerves involved in migraine. There are currently three devices approved by the FDA for migraine treatment, and according to Dr. Stewart Tepper, professor of Neurology at the Geisel School of Medicine at Dartmouth and Director of the Dartmouth Headache Center, interest keeps growing.
In a recent Facebook live chat hosted by the American Migraine Foundation, Tepper answered questions on how these devices can be used for migraine treatment, and explained how people interested in trying this treatment can obtain a prescription.
What we know
The two devices that are FDA approved for migraine treatment are the Transcutaneous Supraorbital Neurostimulator, commonly known as the Cefaly device, and the Single Pulse Transcranial Magnetic Stimulator device, known as SpringTMS. There is one other FDA approved device, the Non-Invasive Vagus Nerve Stimulator, or gammaCore, that has been approved for the acute treatment of cluster headache, but ongoing research suggests that it may also be helpful for the acute and preventative treatment of migraine.
According to Tepper, the flexibility of these devices (in terms of what type of headache they can treat) is still being tested, but they have been proven effective in many cases. For example, the SpringTMS was designed to treat migraine with aura, and has been effective in treating that specific condition. During testing, the device was able to stop both the aura and the migraine that followed. Tepper suggests it first for patients that have migraine with aura as both an acute and preventative treatment.
Neuromodulation devices can also treat people with chronic migraine who experience different types of headache.The SpringTMS device has been proven to help people living with chronic migraine after being tested on patients who had anywhere from four to 25 headache days per month. Research on the gammaCore device suggests that it also may be helpful in treating more than one type of headache, but until it is FDA approved for the treatment of migraine, it can only be prescribed for patients with cluster headache.
What we don’t know
Some neuromodulation devices have yet to be tested on children and pregnant women, and the ones that have did not receive guidelines for use from the FDA. However, regulatory authorities in the UK are close to approving the SpringTMS device for migraine treatment in pregnant women, because the magnets used in the device have a limited range and will not reach the fetus.
The Cefaly and gammaCore devices have not yet been tested on pregnant women, but according to Tepper, there are groups that have shown interested in performing these studies. “We have big hopes that these may be reasonable treatments during pregnancy,” said Tepper.
Getting a prescription
Because these treatments are still new, they are not yet commonly prescribed. To get a prescription, Dr. Tepper recommends visiting your doctor with information on the treatment you want to try and starting the conversation there. The two devices proven to be effective for migraine treatment (Cefaly and SpringTMS) have websites with all the relevant details for obtaining a prescription.
Unfortunately, none of the existing neuromodulation devices are covered by MediCare or MedicAid, and they are more expensive than generic drugs. Our hope is that insurance providers will soon recognize of the value of these treatments based on the interest they have generated in the migraine community. While answering questions from participants in the live chat, Tepper stressed the importance of lobbying your individual insurance providers for coverage.
Knowledge is a powerful tool for migraine management, which it’s important to stay up to date on news and the latest research. The American Migraine Foundation maintains a comprehensive resource library full of fact sheets, toolkits and advice sourced directly from the nation’s leading migraine specialists. Visit AMF’s website to learn more and to find a headache doctor near you.