Devices that can be used to treat headache
What are devices used for?
A lot of people want to use non-drug approaches to help manage their migraine symptoms. There are a range of medical devices which may be beneficial for headache or migraine symptoms. Below is an overview of the devices currently available in the UK.
Cefaly (external trigeminal nerve stimulation)
External Trigeminal Nerve Stimulation is delivered by the Cefaly device which is designed to prevent and treat migraine.
What is external trigeminal nerve stimulation?
Most headaches and migraine involve the trigeminal nerve. The trigeminal nerve is a nerve in the head, part of which runs around above your eye. This is the part of the trigeminal nerve that is stimulated by the Cefaly device.
An adhesive electrode is positioned on the forehead and Cefaly connects to this. Through the electrode, Cefaly generates precise micro-impulses in order to stimulate the nerve endings of the trigeminal nerve.
Neurostimulation of the trigeminal nerve with Cefaly aims to produce a sedative or calming effect. Regular repetition of this effect is thought to reduce the number of attacks of migraine.
Two studies, involving 87 patients, looked at how well the procedure works, and showed the benefits of reduced migraine after 3 months of treatment with the device.
In May 2016 the National Institute for Health and Care Excellence (NICE) published guidance on the use of a transcutaneous electrical stimulation of the supraorbital nerve for treating and preventing migraine, in relation to the Cefaly device. NICE found that there were no major safety concerns, but the evidence for the effectiveness of Cefaly was limited. The NICE recommendation is that Cefaly should only be used with special arrangements for clinical governance, consent and audit or research. If you are interested in trying Cefaly, speak to your doctor initially.
Purchasing a Cefaly device
You can purchase Cefaly privately direct from the Cefaly website. If you try Cefaly, and after 60 days see no benefit you can use the ’60 day Cooling Off Period’. This means they will refund a proportion of the cost of the device, but retain a certain amount to cover the cost of safe disposal.
A study published by Cefaly showed a beneficial difference after two months so users should know if the device is helpful by that time. You can check the terms and conditions of the cooling off period before you purchase a device.
gammaCore (non-invasive vagus nerve stimulation)
gammaCore or nVNS is an approved treatment for cluster headache in the UK. It is a handheld device that is used to treat attacks when they occur, or as a daily preventive treatment. It uses set doses of non-invasive stimulation (nVNS), when held onto the skin to either the right or the left branches of the vagus nerve in the neck.
gammaCore Sapphire is the name of the device and it is rechargeable and reusable. It is activated on a regular basis (usually every three months) with a prescription. An authorised code is delivered to the device using a radio-frequency identification, or RFID, card.
gammaCore is CE-mark approved, meaning it meets the European safety, health, and environmental protection requirements.
How does it work?
gammaCore works by sending a mild electrical stimulation through the skin to activate the vagus nerve from outside your body. It is painless and the level of stimulation can be adjusted to what is comfortable.
Stimulation of the vagus nerve can relieve cluster attacks when they occur and some people also use it as a daily treatment to help prevent attacks.
Approval and Access
In December 2019, the National Institute for Health and Care Excellence (NICE) published guidance on the use of gammaCore and it has now been made available to treat cluster headache on the NHS. It can only be prescribed by a specialist and is not available from your GP.
It is not available for migraine on the NHS. You can pay privately for gammaCore. You would need your specialist to complete the medical authorisation form. For more information about accessing gammaCore and the current cost contact electroCore at firstname.lastname@example.org.
sTMS (single pulse transcranial magnetic stimulation for migraine)
sTMS is a non-invasive and non-drug treatment for migraine. It involves placing the sTMS device against the back of your head for a second to deliver a very brief pre-set magnetic pulse. The device is called sTMS mini. It is portable, rechargeable and reusable. It is activated on a regular basis (usually every 3 months) with a prescription.
How does sTMS work to relieve and prevent migraine?
The sTMS mini device is placed at the back of the head for less than a minute, generating a magnetic pulse that forms a mild electric current at the back of the brain. The number of pulses can be repeated as prescribed by your neurologist. The pulse is painless and generates mild currents in the brain tissue that are believed to interrupt the brain activity linked to migraine. sTMS is painless and causes no serious side effects.
Why choose sTMS
There are many reasons why you may want to use sTMS. These may include:
- if you already use medicines for other conditions and want to avoid drug interactions
- if you have other medical conditions such as heart disease and cannot take triptans and simple painkillers do not work for you
- If you want to cut back on painkillers
- personal preference such as women of child bearing age wishing to avoid medicines
sTMS scientific evidence
Evidence from clinical trials has shown that sTMS can reduce the severity and overall number of migraine attacks. It has been used to treat migraine attacks when they occur and also daily to prevent attacks1234.
It is CE-mark approved, meaning it meets the European safety, health, and environmental protection requirements.
In January 2014 the National Institute for Health and Care Excellence (NICE) published guidance on transcranial magnetic stimulation for treating and preventing migraine.
NICE recommends that sTMS should only be used for the treatment of migraine under the care of a headache specialist.
Access to sTMS
NHS funding for sTMS can be considered by a CCG through an Individual Funding Request (IFR) or special arrangements at some headache clinics. You should contact the headache clinic directly to check if they can prescribe it. Alternatively, patients may self-fund this treatment but will need a prescription from their headache specialist.
Update March 2021
A new investor group has purchased eNeura and are working to make the sTMS available to people with migraine in the UK. For existing users detailed patient guidance is expected soon. As an interim please contact eNeura at email@example.com to have your prescription renewed.