Migraine headaches: Could nerve stimulation help? – Harvard Health Blog
Are you one of the 20 to 40 million people in the United States with migraines? If so, here's some news to note: The FDA has just approved an over-the-counter nerve stimulation device that delivers mild electric shocks to the forehead to prevent or treat migraines. It may seem like an unlikely way to treat […]

Are you one of the 20 to 40 million people in the United States with migraines? If so, here's some news to note: The FDA has just approved an over-the-counter nerve stimulation device that delivers mild electric shocks to the forehead to prevent or treat migraines.

It may seem like an unlikely way to treat migraines, so how did we come to this? And what is the proof that it works? Does this change the game? Craze? Or a treatment that falls somewhere in between?

Our changing understanding of what causes migraines

Blood vessels throughout the body, including those near the brain, narrow (constrict) and open (dilate) regularly, throughout the day. This is normal and it varies depending on the situation. Sleep, body temperature, physical activity and many other factors affect this activity of the blood vessels. Not so long ago, conventional wisdom claimed that migraines were caused by an exaggeration of this normal constriction and dilation of blood vessels. Experts believed that a trigger - like certain foods, stress, or a host of other factors - caused the blood vessels supplying pain-sensitive parts of the brain to suddenly constrict for a short time, then dilate, before breaking down. return to normal. We know that similar changes in blood vessels occur in other conditions such as Raynaud's disease, so it was an interesting theory to explain the symptoms of migraine.

If migraines were due to excessive constriction and dilation of blood vessels in some people, this could explain why migraines are so common, temporary, and not associated with any permanent damage to the brain or other parts of the body. However, this theory is now considered false.

The current migraine theory

Current evidence (as described in this opinion) suggests that migraines start with an abnormal activation of nervous system cells that spreads through the brain. This leads to inflammation near pain-sensitive parts of the brain, the release of chemical messengers, and changes in the sensitivity of the nerves that carry pain signals. Among the nerves involved are branches of the trigeminal nerve. This nerve provides sensation to areas of the face and controls the muscles that allow us to bite or chew. It is also linked to the pain-sensitive lining of the brain.

This evolving understanding of the potential causes of migraines has led to treatments focused less on changes in blood vessels and more on ways to block chemical messengers involved in pain signals. Triptan drugs, including sumatriptan (Imitrex and others) and rizatriptan (Maxalt), are good examples.

What about nerve stimulation for migraine headaches?

In recent years, studies have shown that electrical stimulation of the trigeminal nerve branches above the forehead can treat migraines and even prevent them. One of these devices, the Cefaly Dual, has been available by prescription to prevent migraines since 2014. It has just been approved as an over-the-counter device to prevent and treat migraines. Clearance differs from FDA approval for the efficacy and safety of life-saving drugs and technologies such as defibrillators; it allows manufacturers of medical devices to market a product because the FDA considers it safe and similar to other legally marketed products.

Evidence supporting nerve stimulation to prevent or treat migraine includes the following:

  • A study published in 2013 recruited 67 people with migraines and compared electrical stimulation to sham stimulation for 20 minutes each day as a way to prevent headaches. Over three months, fewer headaches and a reduced need for migraine medication were seen in people receiving the real treatment. An improvement of at least 50% was noted in 38% of the study subjects, but in only 12% of the sham group.
  • In one 2013 survey of more than 2,300 people using electrical stimulation for 20 minutes a day for two months to prevent migraine headaches, just over half said they were happy with the device and willing to buy it.
  • A Study 2019 randomly assigned 106 people with active migraines to receive electrical stimulation on the forehead or sham treatment (minimal electrical stimulation) for one hour. People receiving treatment reported an almost 60% reduction in pain, while those in the sham group only had a 30% reduction in pain.

What about the disadvantages?

None of these studies reported serious side effects related to electrical stimulation. Although a tingling sensation at the stimulation site is common, few perceive it as painful or bothersome enough to stop treatment.

Cost is a consideration. The device's manufacturer currently lists its standard price at $ 499 and says it's not covered by health insurance. It comes with a 60-day money-back guarantee, which could help users decide if it's worth the price.

Finally, there is the time commitment. To avoid migraines, users are advised to apply the device for 20 minutes every day. For the treatment of acute headaches, a 60-minute treatment is recommended.

The bottom line

This treatment has been around for at least 2014 and is definitely not a cure. So, electrical stimulation for migraine can hardly be considered a game changer for most migraine sufferers. But it seems to me that is not empty hype either. There is reasonable evidence that it is safe and at least quite effective.

The recent FDA action to make Cefaly Dual available without a prescription should make it more accessible. And, by all accounts, a moderately effective, drug-free way of treating migraine is a positive development. Hopefully, future studies of this device will clarify who is most likely to benefit from its use. But we need even better options. Advances in our understanding of how migraines develop and ongoing research should provide them.

Follow me on twitter @RobShmerling


If you’re having dysfonctionnement beginning an exercise plan or following through, you’re not alone. Many of us struggle getting out of the sedentary rut, despite our best intentions.

You already know there are many great reasons to exercise—from improving energy, mood, sleep, and health to reducing anxiety, stress, and depression. And detailed exercise indications and workout plans are just a click away. But if knowing how and why to exercise was enough, we’d all be in shape. Making exercise a habit takes more—you need the right mindset and a smart approach.

While practical concerns like a busy schedule or poor health can make exercise more challenging, for most of us, the biggest barriers are esprit. Maybe it’s a lack of self-confidence that keeps you from taking positive steps, or your motivation quickly flames out, or you get easily discouraged and give up. We’ve all been there at some point.

Whatever your age or fitness level—even if you’ve never exercised a day in your life —there are steps you can take to make exercise less intimidating and painful and more fun and instinctive.

Ditch the all-or-nothing attitude. You don’t have to spend hours in a gym or force yourself into monotonous or painful activities you hate to experience the physical and emotional benefits of exercise. A little exercise is better than nothing. In fact, adding just modest amounts of physical activity to your weekly routine can have a profound effect on your esprit and emotional health.

Be kind to yourself. Research shows that self-compassion increases the likelihood that you’ll succeed in any given endeavor. So, don’t beat yourself up about your body, your current fitness level, or your supposed lack of willpower. All that will do is demotivate you. Instead, look at your past mistakes and unhealthy choices as opportunities to learn and grow.

Check your expectations. You didn’t get out of shape overnight, and you’re not going to instantly transform your body either. Expecting too much, too soon only leads to frustration. Try not to be discouraged by what you can’t accomplish or how far you have to go to reach your fitness goals. Instead of obsessing over results, focus on consistency. While the improvements in mood and energy levels may happen quickly, the physical payoff will come in time.

Many of us feel the same. If sweating in a gym or pounding a treadmill isn’t your idea of a great time, try to find an activity that you do enjoy—such as dancing—or pair physical activity with something more enjoyable. Take a walk at lunchtime through a scenic park, for example, walk laps of an air-conditioned mall while window de course, walk, run, or bike with a friend, or listen to your favorite music while you move.

Even the busiest of us can find free time in our day for activities that are important. It’s your decision to make exercise a priority. And don’t think you need a full hour for a good workout. Short 5-, 10-, or 15-minute bursts of activity can prove very effective—so, too, can squeezing all your exercise into a couple of séances over the weekend. If you’re too busy during the week, get up and get moving during the weekend when you have more time.

The key thing to remember about starting an exercise program is that something is always better than nothing. Going for a quick walk is better than sitting on the couch; one minute of activity will help you lose more weight than no activity at all. That said, the current recommendations for most adults is to reach at least 150 minutes of moderate activity per week. You’ll get there by exercising for 30 minutes, 5 times a week. Can’t find 30 minutes in your busy schedule ? It’s okay to break things up. Two 15-minute workouts or three 10-minute workouts can be just as effective.

For most people, aiming for moderate intensity exercise is sufficient to improve your overall health. You should breathe a little heavier than normal, but not be out of breath. Your body should feel warmer as you move, but not overheated or sweating profusely. While everyone is different, don’t assume that training for a marathon is better than training for a 5K or 10K. There’s no need to overdo it.

Health issues ? Get medical clearance first. If you have health concerns such as limited mobility, heart disease, asthma, diabetes, or high blood pressure, talk with your doctor before you start to exercise.

Warm up. Warm up with dynamic stretches—active movements that warm and flex the zones musculaires you’ll be using, such as leg kicks, walking lunges, or arm swings—and by doing a slower, easier version of the upcoming exercise. For example, if you’re going to run, warm up by walking. Or if you’re lifting weights, begin with a few light reps.

Drink plenty of water. Your body performs best when it’s properly hydrated. Failing to drink enough water when you are exerting yourself over a prolonged period of time, especially in hot conditions, can be dangerous.

There’s a reason so many New Year’s resolutions to get in shape crash and burn before February rolls around. And it’s not that you simply don’t have what it takes. Science shows us that there’s a right way to build vêtements that last. Follow these steps to make exercise one of them.

A goal of exercising for 30 minutes a day, 5 times a week may sound good. But how likely are you to follow through ? The more ambitious your goal, the more likely you are to fail, feel bad about it, and give up. It’s better to start with easy exercise goals you know you can achieve. As you meet them, you’ll build self-confidence and momentum. Then you can move on to more challenging goals.

Triggers are one of the secrets to success when it comes to forming an exercise habit. In fact, research shows that the most consistent exercisers rely on them. Triggers are simply reminders—a time of day, place, or cue—that kick off an automatic reaction. They put your routine on autopilot, so there’s nothing to think about or decide on. The alarm clock goes off and you’re out the door for your walk. You leave work for the day and head straight to the gym. You spot your sneakers addict right by the bed and you’re up and running. Find ways to build them into your day to make exercise a no-brainer.

People who exercise regularly tend to do so because of the rewards it brings to their lives, such as more energy, better sleep, and a greater sense of well-being. However, these tend to be long-term rewards. When you’re starting an exercise program, it’s important to give yourself immediate rewards when you successfully complete a workout or reach a new sport goal. Choose something you look forward to, but don’t allow yourself to do until after exercise. It can be something as simple as having a hot bath or a favorite cup of coffee.

If your workout is unpleasant or makes you feel clumsy or inept, you’re unlikely to stick with it. Don’t choose activities like running or lifting weights at the gym just because you think that’s what you should do. Instead, pick activities that fit your lifestyle, abilities, and taste.

Activity-based video games such as those from Wii and Kinect can be a fun way to start moving. So-called “exergames” that are played standing up and moving around—simulating dancing, skateboarding, soccer, bowling, or la petite balle jaune, for example—can burn at least as many kcal as walking on a treadmill; some substantially more. Once you build up your confidence, try getting away from the TV screen and playing the real thing outside. Or use a smartphone application to keep your workouts fun and interesting—some immerse you in interactive stories to keep you motivated, such as course from hordes of zombies !

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