For several years we have been using the TENS machines to stimulate the Peripheral Nervous System in order to get needed relief for chronic neuro-muscular problems. The same physiological principle is being used to stimulate the Central Nervous System. One of the stealthiest developments in the treatment of Migraines has been the technological development of devices that will control the episodes. Various regulatory issues have delayed their introduction in the commercial market but they will soon become an option if insurers start to cover them. Here is a review of the three devices that have been approved by the FDA.

Transcutaneous Supraorbital Neurostimulation. It is the first device that was approved by the FDA and its commercial name is “Cefaly.” It is applied on a set of electrodes on the forehead to stimulate both supraorbital nerves. According to a scientific study the device must be used for 20 minutes per day for at least three months in order to noticed a significant reduction of headache days. It has both a high-intensity and low-intensity settings in the USA; in the EU and Canada it has a preventive, acute and chronic settings. With an approximate cost of U$ 400, it is not yet covered by the Payors.

Single-Pulse Transcranial Magnetic Stimulation. The second approved device is a single-pulse transcranial magnetic stimulator that is commercially available under the name “Spring TMS”; it is applied in the back of the skull and sends pulses forward up to the frontal area. It blocks the slow activation of cortical neurons dubbed as “cortical spreading depression” (CSD) that forms the basis of the auras patients experiment before an attack. A study found it effective at the beginning to wipe out the aura and the expected fit; the FDA has approved the deployment of two pulses right before an attack. In a preventive mode, 4 pulses are applied in both the morning and at night.It is only available to rent for 3 months with a price of U$ 150 per month.

Non-invasive Vagal Nerve Stimulation. The third device is a stimulator of the vagus nerve placed on the neck that is used for cluster headaches and set at two cycles in the treatment and prevention protocols. Two studies have shown that it can end an acute episode of cluster headache but it was not effective in the treatment of chronic cluster attacks. Also not effective in chronic migraines after 2 months, it might be effective at longer time points. It can block the CSD and down-regulate the thalamo-cortical pathways.

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