Advances in non-drug therapies for migraine
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Advances in Non-Drug Therapies 
for Migraine
If you follow our Twitter postings with any degree of regularity you may recognize many of the devices/procedures summarized here. It was the recent release of the Cefaly II device that caused me to think that our followers deserved an up-to-date look at the devices available, especially if one was looking to add it to their treatment regimen.  Migraine treatment research has recently enjoyed a considerable, and hopeful, boost in both productivity and visibility. No doubt much of this is prompted by the potential market of 36 million enthusiastic consumers. The research, and resulting market, has diverged in a number of interesting, if different, courses. This brief discourse is intended to focus on non-pharmaceutical, non-invasive, medical devices. In short, something you apply or wear. Here they are, in no particular order: 

Cefaly I and Cefaly II

The futuristic looking Cefaly units are a new take on an old standard:  the TENS unit. TENS is an acronym standing for Transcutaneous Electrical Nerve Stimulation. Wearing it daily for about 20 minutes is reputed to have migraine prevention qualities. The devices also boasts other settings for acute attacks and anxiety. The primary difference between Cefaly I and Cefaly II is size, with the latter being much smaller.  Research results do show positive results from consistent Cefaly use (>30 days). Anecdotal data swings in both directions. For example, at the AAOHNS Annual Meeting I was stopped by a woman in her 60s who stated emphatically after less than a month's use of Cefaly I she stopped getting the CM that plagued her life for 40 years.  Other reports tell of disgruntled users returning the device to the manufacturer, complaining of no effect at all. Will it work for you? The price tag (besides your time) is about 350USD give or take.

eNeura Transcranial Magnetic Stimulation, Spring TMS

This device, when applied at the onset of a migraine with aura, purports to "interrupt the abnormal electrical activity associated with migraine and cortical spreading depression (CSD)". This brief pulse of electrical energy is thought to effectively disrupt the development of the migraine.  As far as we can see there is no large scale, peer reviewed research available to aid in your decision making. An April 2010 Lancet article, featured on the manufacturers home page, describes a "promising" treatment. There are a number of anecdotal reviews you can find online, however, if attempting to establish efficacy you may want a larger sample than 1 or 2. Anecdotal data is usually how the research ball gets rolling, just don't read too much into it initially. Especially if other treatments are being applied simultaneously. Also, at this point, you cannot purchase the medical device, only rent it. The initial cost , all in, for the first few months is about 800USD. 

Non Invasive Vagus Nerve Stimulation (nVNS)

Stimulation of the Vagus nerve also holds promise in the neuromodulation area. Although it's introduction to the general public of migraineurs may lag a bit behind the marketing of Cefaly and eNeura, gammaCore does have a recent peer reviewed article:

Vagus nerve stimulation sends electrical signals along a nerve, of the same name, parts of which run through the neck to the brain. The actual physiology of how nVNS prevents or aborts migraines is poorly understood. This procedure is also being investigated for cluster headaches. One study in the UK, showed about 50% of the participants receiving a benefit. At King's College in London, Dr. Peter Goadsby acknowledges "if a proportion of people with a dreadful problem get some benefit, that's a good step forward".  The cost for the medical device is around 300USD, but here may be training and related fees attached. It is only available through a physician.

In closing, none of these devices are 100% effective, nor do they claim to be.  More research, in varying degrees, is needed by all three devices. Will one of them work for you? Time and well-designed research will tell. Be your own advocate and investigate all approaches carefully. In addition, there may be a clinical trial you could qualify for, and evaluate the device free of charge.

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