A New Drug-Free Option For Migraine Prevention

In a recent clinical trial, scientists have discovered a potential new drug-free option for migraine prevention called remote electrical neuromodulation (REN).¹ 

Migraines affect about 14% of the global population or more than one billion people worldwide.² Unfortunately, there may be more people suffering from migraines than we realize because they are often underdiagnosed and undertreated. While there are some medications available for migraines, they only manage symptoms after they occur, and do not work for everyone. This is why clinical research on migraine prevention is vital.

Not only are migraines agonizing, but they can be disabling and disrupt work and social lives. Furthermore, migraines can damage both our physical and mental health by increasing the risk of stroke and heart conditions, anxiety, depression, and sleep disorders.³   

What is a migraine?

A migraine is more than just a bad headache. A migraine is a painful and disabling headache disorder that is characterized by:

• throbbing pain on one side of the head, 
• moderate or severe pain levels,
• is lasting for 4 to 72 hours,
• is made worse by even light physical activity.⁴

Additionally, symptoms such as nausea, vomiting, and sensitivity to light and sound may be present.⁴

Types of migraines

There are two main types of migraines: migraines with aura and migraines without aura. An aura is a temporary disturbance in the senses that acts as a sort of warning sign of an oncoming migraine attack. An aura can also happen during the actual migraine attack. A person suffering from migraine with aura may experience:

• changes in vision (e.g. blurry vision, blind spots, flashing lights, and zig-zag patterns),
• changes in speech and understanding (e.g. struggling to speak to or understand others all of a sudden),
• numbness or tingling sensations in parts of the body,
• or dizziness and loss of balance.⁴

How are migraine symptoms currently treated?

During a migraine attack, people will usually take acetaminophen or ibuprofen to help ease the symptoms. However, if those over-the-counter pain medications do not help, the next step is typically a visit to a doctor.

The doctor might prescribe migraine-specific medications, non-specific medications, or a mixture of both. Below are some examples of medications that are typically recommended:

Migraine-specific^5,6

• Triptans (e.g. sumatriptan, eletriptan, zolmitriptan).
• Gepants (e.g. rimegepant, ubrogepant).
• Ergotamines (e.g. dihydroergotamine).

Non-specific^5,6

• Anti-nausea meds (e.g. prochlorperazine).
• Anti-seizure meds (e.g. topiramate, valproate).
• Beta-blockers (e.g. propranolol, atenolol, metoprolol).
• Antidepressants (e.g. amitriptyline, duloxetine).

People taking migraine medications can experience unpleasant side effects. These medications can also have drug-drug interactions. Also, some people cannot take them at all due to certain health conditions. Lastly, migraine-specific medications can be expensive. For these reasons, doctors have emphasized that preventive methods like REN are worth exploring.¹

What is REN?

Remote electrical neuromodulation (REN) is a method that uses electrodes to activate the body’s natural pain management system and influence how pain signals are transmitted. Nerivio, an FDA-approved REN device, is worn on the arm and can be controlled with a mobile app. The device gently stimulates the nerves in your upper arm, reducing pain signals to the head. Scientists theorized that with repeated use, REN could strengthen the body’s pain management system and increase the natural ability to prevent migraines.¹

The REN clinical trial

Researchers recruited participants who experienced either migraines with aura or migraines without aura. One group was given the real REN device, while the other group was given a copycat version. Neither the participants nor the scientists knew who had the real device until the end of the study.¹ 

Every two days, the participants wore their REN devices for 45 minutes and answered nightly questionnaires using an electronic diary. If they had a migraine attack, they couldn’t use the device to treat it but could use other common treatments.

By the end of the 16-month study, the group that used the real REN device experienced an average decrease of four migraine days per month, compared to just 1.3 migraine days for the other group. The real REN device group also reported lower pain levels and used fewer medications for acute migraine attacks.¹

What does this all mean?

Migraines affect many people worldwide, can be debilitating, and have a negative impact on various aspects of a person’s life. Remote electrical neuromodulation (REN) is a new treatment method that could be a great option for migraine prevention. With just the touch of a button, people may finally have greater control over their migraines, rely less on medications, and potentially improve their quality of life.

References

1. Tepper SJ, Rabany L, Cowan RP, et al. Remote electrical neuromodulation for migraine prevention: A double-blind, randomized, placebo-controlled clinical trial. Headache. 2023;63:377-389. doi: 10.1111/head.14469
2. The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. J Headache and Pain. 2022;23(1). https://doi.org/10.1186/s10194-022-01402-2
3. Buse DC, Reed ML, Fanning KM, et al. Comorbid and co-occurring conditions in migraine and associated risk of increasing headache pain intensity and headache frequency: results of the migraine in America symptoms and treatment (MAST) study. J Headache Pain. 2020;21(1):23. https://doi.org/10.1186/s10194-020-1084-y
4. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629-808. doi:10.1177/0333102413485658.
5. Sinclair AJ, Sturrock A, Davies B, Matharu M. Headache management: Pharmacological approaches. Pract Neurol. 2015;15(6):411-423. doi:10.1136/practneurol-2015-001167
6. VanderPluym JH, Halker Singh RB, Urtecho M, et al. Acute treatments for episodic migraine in adults: A systematic review and meta-analysis. JAMA. 2021;325(23):2357–2369. doi:10.1001/jama.2021.7939