Migraine Treatment of the Month
With so many new therapies for migraine rapidly becoming available, it was difficult to pick one single therapy to highlight in this issue.
In part because it is a device rather than a drug, in part because unlike many other devices its safety and effectiveness were demonstrated in a rigorously conducted clinical research study, and in part because we simply found the device to be especially nifty when we tried it ourselves, Nerivio was our choice for “treatment of the month.”
Noninvasive neuromodulation represents an intriguing non-pharmacologic alternative for pain management. Conditioned pain modulation (CPM) is an endogenous mechanism for pain suppression wherein sub-painful electrical stimulation may inhibit pain perceived in regions remote from the site of stimulation. The Nerivio device is attached to the upper arm. After appropriate programming in your cell phone, the device delivers a noticeable but not uncomfortable electrical stimulus across the skin.
The results of a double-blind, placebo-controlled study published in the journal Headache in 2019 demonstrated that CPM induced by remote electrical neuromodulation (REN) via the Nerivio device might be a safe, effective and well-tolerated treatment for acute migraine. For each of the clinical endpoints prospectively chosen in the study, REN proved superior to sham stimulation. The rates of pain relief and pain freedom were at least as impressive as what has been published from studies involving the oral triptans.
Nerivio requires a prescription and, at this point, can be obtained only through a single specialty pharmacy. Each device is capable of administering 12 treatments, and the cost of each treatment averages out to a little more than $8.
Remote electrical neuromodulation appears to represent a welcome non-pharmacologic addition to the arsenal of therapies available for acute migraine treatment, and REN may be a particularly attractive alternative in circumstances when other therapeutic alternatives have been ineffective, poorly tolerated or are contraindicated.
For more information regarding the Nerivio device go to nerivio.com or call 866-NERIVIO.