New cell-phone-sized device may prevent migraine headache

If your bank account balance looks nail-bitingly low and you won’t get paid for days, you might agonize over every dollar you spend.

Maybe you’ll scrutinize grocery-store ads more closely than usual or brew your own coffee instead of ordering it from a barista.

Migraine patients can face a similar sense of scarcity when it comes to migraine medications.

Drugs called triptans are the mainstay of migraine treatment. But typically, patients can’t take them more than twice a week.

If they have a third migraine, they’re out of luck.

But a new study reports a new way to treat—and prevent—migraine attacks without this limitation: neuromodulation.

The research was conducted by a team at West Virginia University.

According to the team, neuromodulation is a way to manipulate the central pain system by applying electrical or magnetic pulses to specific nerves or areas of the brain.

In the study, neuromodulation takes the form of a cell-phone-sized device that stimulates the vagus nerve.

The longest cranial nerve in the human body, the vagus nerve charts a circuitous route from the brain stem through the face, neck, chest, and abdomen.

The traditional vagus nerve stimulator, which has been used for epilepsy seizure patients for many years, is an implanted device.

But the new device is noninvasive. It’s applied to the neck, and it stimulates the vagus nerve in a proprietary manner that causes changes in certain areas of the brain stem involved in the migraine process.

By downregulating those migraine-related areas, it can disrupt an ongoing migraine attack, or if it’s used three times a day, every day, it prevents the migraine attacks from coming on.

ElectroCore—a corporation that specializes in neuromodulation technologies—makes the device and funded the trial.

Previous animal studies and medical-imaging data suggest the device is effective at preventing and combatting migraine attacks.

Now the team wants to know how well it performs for actual migraine patients.

The researchers are enrolling participants in a six-month trial that will pit the device against a “sham” version that looks and feels like the real thing but doesn’t affect the vagus nerve.

During the first three months, half of the participants will apply the nerve stimulator to their necks for two minutes, three times a day. The other participants will do the same, using the replica.

For the next three months of the study—called the “open-label phase”—all of the participants will use the real device (open-label phase).

Participants will keep a daily, electronic headache diary. If they skip a day or don’t provide all of the information they’ve asked for, a dashboard will notify the research team, and a coordinator will call the patients, reminding them to complete the task.

Every four weeks, the participants will also visit the WVU Headache Center so that a doctor can assess their migraine symptoms and determine if they’re improving.

These symptoms go beyond pain. They can comprise visual auras, dizziness, imbalance, light and sound sensitivity, cognitive slowing, nausea, and vomiting.

In addition, taking too much of a triptan can trigger a headache.

The drawbacks of triptans don’t end there. Some people can’t take them because they have health conditions that triptans might exacerbate.

Some can’t take them because another drug they rely on doesn’t play nicely with triptans.

In people who can take triptans safely, the medication can still cause unpleasant side effects, including chest tightness, muscle stiffness, sleep disturbances including excessive sedation, anxiety and a warm sensation under the skin.

And triptans aren’t used to prevent migraine attacks—just to cut them short.

The team says in the future, wearables might be able to give people a migraine warning—like a weather alert—based on their physiological state.

Then they can try to thwart the attack. Maybe they’ll avoid that one grocery store where the fluorescent lighting always sets off an attack.

Maybe they won’t have that cup of coffee after all because caffeine is one of their migraine triggers.

One researcher of the study is West Virginia University neurologist Umer Najib.

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