Remote Electrical Neuromodulation as a Potential Migraine Prevention Tool

Remote electrical neuromodulation, compared with placebo, led to a greater reduction in monthly migraine days from baseline in patients with episodic and chronic migraine.

Remote electrical neuromodulation (REN) applied every other day was found to be safe and effective at preventing migraine, according to study results presented at the 2023 American Academy of Neurology (AAN) Annual Meeting, held from April 22 to 27, in Boston, Massachusetts.

More than 1 billion individuals are affected by migraine worldwide and those affected can experience significant disability. As such, migraine is associated with significant socioeconomic burden, making it a priority to find effective preventative strategies. REN is a nonpharmacological treatment for acute migraine which has application for both episodic and chronic migraine.

In this prospective, randomized, double-blind, sham-controlled trial conducted at multiple sites, researchers observed patients (N=248) with migraine for 4 weeks and then randomly assigned them in a 1:1 ratio to receive REN (n=128) or sham (n=120) treatment every other day for 8 weeks. The primary outcome was the change in monthly migraine days as recorded in a daily migraine diary. This analysis reported results from the modified intention-to-treat population, which comprised of 179 individuals randomly assigned to receive REN (n=95) or sham (n=84) treatment.

The change in the mean monthly migraine days compared with baseline was -4.0 (SD, 0.4) days for REN recipients compared with -1.3 (SD, 0.4) days for sham recipients. Overall, REN associated with 2.7 fewer migraine days a month from baseline relative to placebo (P =.00002).

Applied every other day, REN is effective and safe for the prevention of migraine.

Stratified by type of migraine, REN associated with a greater reduction in monthly migraine days from baseline compared with placebo among patients with episodic (mean, -3.2 vs -1.0 days; P =.003) or chronic (mean, -4.7 vs -1.6 days; P =.001) migraine, respectively.

Similarly, REN was superior to sham treatment at reducing monthly migraine days among the subset of patients who did (mean, -3.5 vs -1.5 days; P =.03) and did not (mean, -4.5 vs -1.5 days; P =.00016) use migraine preventative treatments, respectively.

No serious adverse events related with treatment were reported in this study.

The major limitation of this study was the short study duration. Additional studies are needed to assess long-term outcomes of REN.

This study indicated that REN may be a viable migraine preventative strategy in the setting of both episodic and chronic migraine. The researchers concluded, “Applied every other day, REN is effective and safe for the prevention of migraine.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Tepper S, Rabany L, Cowan R, et al. Significant reduction in migraine days with remote electrical neuromodulation (REN) for migraine prevention: a double-blind randomized sham-controlled clinical trial. Abstract presented at: 2023 AAN Annual Meeting; April 22-27, 2023; Boston, MA. Abstract S47.010.