Remote electrical stimulation (RES) is an effective, noninvasive, nonpharmacologic alternative treatment to traditional medications for acute migraine, according to results of a clinical study reported in Neurology.1
A 50% reduction in pain was reported by 64% of participants in a double-blind, randomized, crossover, sham trial conducted in 71 patients, using a noninvasive stimulation device (Nerivio Migra, Theranics Ltd) for 299 treatments.
The participants were trained in the use of the device, involving an armband of electrodes placed on the upper arm coordinated through a customized cell phone app for self-reporting of responses. The study authors designed a protocol to activate the pain inhibitory center in the brain, using remote stimulation at levels lower than normal pain perception to trigger the conditioned pain modulation effect, although some participants still rated the treatment as “painful” (11% vs 1% placebo) or “unpleasant” (28%/13%). Most, however, found the stimulation (both RES and placebo) to be “pleasant” (58%/61%), or even “very pleasant” (4%/25%).
A number of parameters were examined, including multiple pulse (P) widths (P200, P150, P100, and P50 μs) and frequencies (80-120 Hz) compared with a sham (placebo) protocol of 0.1 Hz for 45 μs. Migraine pain at baseline and after treatment was graded as no (0 or 1), mild (2 or 3), moderate (4-6), or severe (7-10) pain. Overall, 76% of active participants reported pain reduction of at least 1 pain grade, and a 50% pain reduction was recorded by 46%, 48%, 39%, and 44% of patients using the P200, P150, P100, and P50 settings, respectively, compared with 26% for placebo.
The participants agreed to avoid taking any medications for 2 hours while using the RES. Approximately 30% of participants were pain free 50% of the time at 2 hours after treatment at the P200 setting compared with 6% for placebo. Twenty-four of 54 attacks (44%) that were rated “mild” at onset were completely resolved using P200 RES compared with 25% (6/24) using sham technology.
Timing of treatment was an important factor in significance of response, which was highest when RES was self-administered to either group within 20 minutes of migraine onset compared with starting 60-180 minutes later (46.8% vs 24.9% mean pain reduction; P =.02) When started more than 60 minutes after pain onset, complete pain reduction did not occur.
The results of the study indicated pain relief across a range of pain grades and to degrees similar to what has been reported for triptans2 and other traditional therapies,3 particularly when used at the highest setting within 20 minutes of pain onset. Ultimately, the authors found RES to be a suitable nonpharmacologic alternative for acute treatment of migraine.
- Yarnitsky D, Volokh L, Ironi A, et al. Nonpainful remote electrical stimulation alleviates episodic migraine pain [published online March 1, 2017]. Neurology. doi: 10.1212/WNL.0000000000003760
- Mullins CD, Weis KA, Perfetto EM, et al. Triptans for migraine therapy: a comparison based on number needed to treat and doses needed to treat. J Manag Care Pharm. 2005;11(5):394-402. doi: 10.18553/jmcp.2005.11.5.394
- Finnerup NB, Otto M, McQuay HJ, et al. Algorithm for neuropathic pain treatment: an evidence-based proposal. Pain. 2005;118:289-305. doi: 10.1016/j.pain.2005.08.013