A new randomised controlled trial reports that stimulation of the largest facial nerve can treat a migraine attack.
Most of us are familiar with taking medicines to treat a migraine attack – paracetamol, a non-steroidal anti-inflammatory such as aspirin or ibuprofen, a triptan – but new treatments target the nervous system through devices, with no swallowing required. This type of treatment is known as neuromodulation or neurostimulation and works by changing the activity of nerves through electrical currents or magnets. Migraine disease is a neurological condition and migraine attacks occur when pathways in the brain become overactive and release chemicals that trigger pain and inflammation. It makes sense, then, that modifying the activity of these sensitised nerves can help treat a migraine attack.
There are several different types of neuromodulation devices available that target different parts of the nervous system. Only one of them is currently approved for use in Aotearoa New Zealand. This is an electrical nerve stimulator that targets the trigeminal nerve, which is the largest and most complex of the cranial nerves that supply the head and face. The device is attached to the forehead with sticky reusable pads and produces an electric current to stimulate the trigeminal nerve through its branches that emerge over the eye.
One of these external trigeminal nerve stimulators (eTNS) was the subject of a randomised controlled trial, the results of which were published in March 2022. In the trial, people with migraine were given a real eTNS or a sham device, which looked identical to the real one but delivered a non-therapeutic level of stimulation. When a moderate to severe migraine attack occurred, participants applied the eTNS for two hours and recorded their pain levels and other migraine symptoms.
Those who had the real eTNS were more likely to be pain-free at two hours compared to those with the sham device, had higher pain relief and were more likely to be free of their most bothersome non-headache symptom (sensitivity to light or sound, nausea and vomiting). Freedom from pain and pain relief were also higher at 24 hours in the group with the real eTNS device.
These positive effects were relatively modest. For example, 25% of people with the real device were pain free at two hours, compared to 18% of people with the sham device. Pain relief, which was defined as a reduction in pain from moderate or severe to mild or absent, was 56% in those using the real device and 42% in those using the sham device.
However, the benefits were significant and these devices offer an alternative to drugs which may be especially attractive to those of us who feel sick and vomit during a migraine attack. No serious side effects were reported and the most common issues with using the device were discomfit, burning and altered sensation in the forehead where the electrode pad was applied. These symptoms resolve with removal of the pad. The eTNS devices are not to be used in anyone with an implanted metallic or electronic device in the head or anyone with a cardiac pacemaker or defibrillator, due to the possibility of the electric currents from the eTNS interfering with the other devices.
This study tested the Cefaly device which has not yet been approved in Aotearoa New Zealand and does not have a distributor here, but a comparable TENS device called Qalm, by PainGone, is available in New Zealand and is recognised by MedSafe. You can order Qalm through the website: www.paingone.com/nz/ and use the code MIGRAINEFANZ to receive 20% off. For every Qalm purchased using this discount code, Migraine Foundation Aotearoa New Zealand receives a small donation.
Qalm is also available at various New Zealand retailers (information on the PainGone website).