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Complete Guide to Neuromodulation Devices for Migraine Treatment (2025)

Posted on May 09 2025, By: Cerebral Torque

Neuromodulation Devices for Migraine Treatment

A comparison of neuromodulation techniques for migraine management

Device/Technique	Type	Target & Mechanism	Treatment Protocol	Efficacy for Migraine	Level of Evidence	Common Side Effects
Transcutaneous Supraorbital Nerve Stimulation (t-SNS/e-TNS) Cefaly® and HeadaTerm®	Non-invasive Wearable device	Stimulates branches of the ophthalmic nerve in the forehead through a small electrode. Acts like a specialized TENS unit that modulates pain signals from trigeminal pathways.	Prevention: 20-minute daily sessions, preferably in the evening; max intensity 16 mA, 60 Hz frequency. Acute treatment: 60-minute session at first sign of migraine attack using higher frequency "ACUTE" program; can be used for up to two consecutive sessions (2 hours total).	38.2% of patients achieved ≥50% reduction in monthly migraine days in episodic migraine. For chronic migraine, about 19% achieved significant reduction. For acute treatment, 29% reported complete relief after 1-hour session.	Moderate Multiple controlled trials	Tingling or burning sensations at application site, skin irritation, sleepiness; most side effects diminish with continued use
Non-invasive Vagus Nerve Stimulation (nVNS) gammaCore Sapphire™	Non-invasive Handheld device	Delivers mild electrical stimulation to the cervical branch of the vagus nerve in the neck. Modulates pain pathways by affecting neurotransmitter release and inhibiting trigeminal nociception.	Prevention: Two 2-minute stimulations (one on each side) twice daily. Acute treatment: Two 2-minute stimulations concurrently with acute medication.	10% of patients with chronic migraine achieved ≥50% reduction in headache days. Overall response rate across studies is approximately 31%.	Moderate Randomized controlled trials	Neck pain, muscle contractions at stimulation site, skin irritation, temporary dizziness; generally well-tolerated
Remote Electrical Neuromodulation (REN) Nerivio®	Non-invasive Wearable device	Stimulates peripheral nerves in the upper arm to activate conditioned pain modulation (CPM), a natural pain-relieving mechanism that inhibits pain signals via descending pathways.	Prevention: 45-minute sessions every other day. Acute treatment: 45-minute sessions at migraine onset.	51.6% of patients achieved ≥50% reduction in headache days; average reduction of 4 monthly migraine days reported in clinical trials.	High Multiple robust clinical trials	Temporary arm/shoulder numbness, tingling, warmth sensation, mild muscle spasms; generally well-tolerated
Dual-channel External Trigeminal-Occipital Neurostimulation Relivion®	Non-invasive Wearable device	Simultaneously stimulates trigeminal nerve branches (supraorbital, auriculotemporal) and occipital nerves. The dual-channel approach targets multiple pain pathways involved in migraine.	Prevention: Daily 20-40 minute sessions. Acute treatment: 1-hour session at migraine onset.	46-60% of patients achieved ≥50% reduction in migraine days; approximately 3-day reduction in monthly migraine days.	Moderate Growing clinical evidence base	Localized tingling, scalp discomfort, temporary skin redness, muscle twitching; most patients adapt to sensations
Single-pulse Transcranial Magnetic Stimulation (sTMS) sTMS mini™ (eNeura)	Non-invasive Handheld device	Delivers brief magnetic pulses to the occipital cortex, primarily targeting migraine with aura. These pulses may inhibit cortical spreading depression and modulate hyperexcitable neurons.	Prevention: 4 pulses twice daily. Acute treatment: 3 pulses at onset, repeated up to 3 times if needed.	46% of patients achieved ≥50% reduction in headache days; effective for both prevention and acute treatment, especially in migraine with aura.	Moderate Clinical trials plus open-label data	Mild scalp discomfort, temporary lightheadedness, tingling sensations, transient hearing changes
Repetitive Transcranial Magnetic Stimulation (rTMS)	Non-invasive Clinical procedure	Delivers repeated magnetic pulses to specific cortical targets (dorsolateral prefrontal cortex, primary motor cortex, frontal cortex) to modulate neuronal excitability and pain networks.	Multiple clinical sessions (typically 5-23) with various stimulation parameters; high-frequency (10-20 Hz) or low-frequency (≤1 Hz) protocols.	Up to 78.7% response rate reported for high-frequency stimulation; more effective when applied to left frontal cortex.	Moderate Multiple controlled studies	Scalp discomfort during sessions, post-treatment headache, transient dizziness, fatigue, mild neck pain
Transcranial Direct Current Stimulation (tDCS)	Non-invasive Clinical procedure	Applies low-intensity electrical current to various cortical targets (motor cortex, visual cortex, prefrontal cortex) to modulate neuronal excitability and normalize cortical activity patterns.	Typically 1-3 mA current for 20-30 minutes per session; daily or several times weekly for 1-5 months.	Up to 81.8% achieved ≥50% reduction in headache days or attack frequency, depending on stimulation parameters and target.	Moderate Growing research base	Tingling, itching, or burning sensations under electrodes, temporary fatigue, mild headache during initial sessions
Occipital Nerve Stimulation (ONS) Various implantable systems	Invasive Surgical implant	Surgical implantation of electrodes adjacent to greater and/or lesser occipital nerves, connected to an implanted pulse generator. Modulates nociceptive processing in the trigeminocervical complex.	Continuous or cyclic stimulation delivered via implanted electrodes; programming adjusted based on patient response.	Approximately 36.3% of patients achieved ≥50% reduction in headache frequency; reported reductions of 6-12 headache days per month.	Moderate Several controlled trials	Risk of infection, lead migration, battery depletion requiring replacement, hardware complications, implant site pain, muscle spasms
Deep Brain Stimulation (DBS)	Invasive Neurosurgical procedure	Electrodes surgically implanted in deep brain structures (hypothalamus, anterior thalamus, or subthalamic nucleus) connected to an implanted pulse generator. Modulates central pain networks.	Continuous stimulation following surgical implantation; reserved for extremely refractory cases after failure of all other treatments.	Limited to case reports of complete remission or significant reduction in migraine attacks; insufficient data for statistical analysis.	Very Low Limited to case reports	Serious risks including intracranial hemorrhage, infection, neurological deficits, hardware complications, and standard neurosurgical risks
High-Frequency (10 kHz) Spinal Cord Stimulation (HF-10 SCS) Senza® System	Invasive Surgical implant	Electrodes surgically implanted at the high cervical (C2-C3) spinal cord level, connected to an implanted pulse generator. High-frequency stimulation modulates pain signals via the dorsal columns.	Continuous high-frequency stimulation following surgical implantation; programming adjusted based on individual response.	50-71% of patients achieved ≥50% reduction in headache frequency or pain intensity; mean pain reduction of approximately 60%.	Low Promising early evidence	Lead migration, infection, implant site pain, hardware-related complications, standard surgical risks; requires comprehensive evaluation

Based on systematic reviews and clinical trials. Efficacy percentages indicate patients who achieved ≥50% reduction in headache days. Evidence graded according to the GRADE framework. Consult with a healthcare provider to determine appropriate treatment options.

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