How To Use TENS Unit for Migraine & Headache Relief
- Sam Kelokates
- Dec 29, 2025
- 6 min read
Updated: 4 days ago
If you’re exploring tools like TENS (Transcutaneous Electrical Nerve Stimulation) to manage migraine pain, you’re not alone. Many people seek non-pharmacological options that work alongside professional care.
At Kelos Physical Therapy, we help people pursue a path to more headache-free days by combining targeted therapies like TENS with personalized physical therapy and structured programs such as the Active Headache Recovery program.
👉 Learn more about your options: Your Path to More Headache-Free Days
Precautions and Potential Side Effects (warning video!)
How TENS Works for Migraine
Transcutaneous Electrical Nerve Stimulation (TENS) is a non-invasive therapy that delivers low-level electrical stimulation through electrodes placed on the skin. When used for migraine, electrodes are typically positioned near areas of pain or along nerves involved in migraine physiology.
The electrical signals produced by a TENS unit activate sensory nerves and can interfere with the transmission of pain signals traveling toward the brain. This stimulation often creates a mild tingling or numbing sensation over the treated area.
In addition to altering pain signaling, TENS may promote the release of endorphins, the body’s natural pain-modulating chemicals, which can further support symptom relief.
TENS devices allow adjustments to settings such as frequency, intensity, and pulse duration, making it possible to tailor stimulation to individual comfort and tolerance.
Beyond head pain, TENS is also commonly used to address associated neck, shoulder, and jaw pain caused by TMD that may occur alongside migraine.
Theoretical Basis for TENS in Migraine
One of the primary explanations for how TENS reduces pain is the Gate Control Theory of Pain. This theory suggests that pain perception is not solely dependent on tissue injury but is also shaped by how signals are processed within the nervous system.
According to this model, sensory input entering the spinal cord passes through a “gate” that can either amplify or dampen pain signals before they reach the brain. When non-painful sensory input is increased, the gate may partially close, reducing the amount of pain information transmitted.
TENS is thought to work within this framework by activating sensory nerve fibers, which can limit the passage of pain signals and decrease perceived pain. This mechanism supports its use as a non-pharmacological option for managing migraine, as well as other headache types such as tension-type and cervicogenic headache.
While traditional TENS units rely on generalized sensory stimulation, newer migraine-specific neuromodulation devices are designed to target precise nerve pathways involved in migraine. These devices use similar principles but apply them in a more condition-specific way.
👉 Learn more about migraine-specific neuromodulation devices here → Neuromodulation Device for Rapid Migraine Relief
Different Modes of TENS Stimulation
TENS units offer multiple stimulation modes, each designed to influence pain in slightly different ways. Selection often depends on symptom type, location, and individual response.
Conventional TENS: Uses high-frequency stimulation (typically 50–100 Hz) with short pulse durations and low intensity. This mode primarily targets sensory nerves and produces a tingling or numbing sensation, offering short-term pain relief.
Burst TENS: Delivers brief bursts of high-frequency stimulation separated by pauses. This approach may be useful for individuals who do not respond well to conventional settings.
Modulation TENS: Alternates stimulation parameters such as frequency or intensity to reduce nervous system accommodation. This variation may help maintain effectiveness over longer sessions.
Acupuncture-like TENS: Applies low-frequency stimulation with longer pulse durations and higher intensity, aiming to produce a deeper response similar to acupuncture techniques. It is often explored for persistent or chronic pain patterns.
Brief Intense TENS: Provides high-intensity stimulation for very short durations, generally under five minutes, and is sometimes used for rapid relief of acute pain.
In migraine-specific research, most studies utilize parameters consistent with conventional TENS. These settings are intended to selectively stimulate sensory nerves involved in migraine pain pathways.
As with any therapeutic tool, guidance from a healthcare provider is recommended to determine appropriate settings and ensure safe, effective use. Individual responses to TENS can vary, and no single mode is universally effective for everyone.
Effectiveness of TENS for Migraine
The role of transcutaneous electrical nerve stimulation (TENS) in migraine prevention has been increasingly studied in recent years. A comprehensive review published in 2022 by Evans and colleagues examined 14 clinical trials involving a total of 995 participants. These studies included both controlled and uncontrolled designs and evaluated TENS as a preventative intervention.
Across the trials, TENS was associated with meaningful reductions in headache frequency for both episodic and chronic migraine. Individuals with episodic migraine experienced an average decrease of approximately 2.8 headache days per month, while those with chronic migraine saw a reduction of just under 3 headache days per month.
The authors concluded that TENS represents a promising non-pharmacological option for migraine prevention. Importantly, it was also found to be safe and well tolerated, with minimal adverse effects reported across studies.
TENS has also been investigated as an acute treatment during migraine attacks. In a randomized controlled trial conducted in an emergency department setting, researchers evaluated the effects of TENS during active migraine episodes. Participants were randomly assigned to either an active TENS group or a placebo group and received a 20-minute treatment session.
Results from this study showed that individuals receiving active TENS experienced significant pain reduction beginning during the treatment period, with continued improvement observed for up to two hours after the device was initiated.
These findings suggest that TENS may provide relatively rapid symptom relief when used during an acute migraine attack.
Taken together, current research supports TENS as a potentially effective non-pharmacological option for both the preventative management of migraine and the treatment of acute episodes, though individual responses may vary.
How to Apply TENS for Migraine
When using TENS for migraine, electrode placement is an important consideration. Common locations used in both clinical practice and research include areas over the supraorbital and occipital nerves, which are frequently implicated in migraine-related pain.
The supraorbital nerves are located along the forehead, just above the center of each eye. The occipital nerves are found at the base of the skull, typically near the lower edge of the hairline on the back of the neck.
Below are general guidelines for applying a TENS unit safely and effectively:
Ensure the device is powered off before placing electrodes.
Identify the target area where stimulation will be applied, such as the forehead or base of the skull.
Clean the skin thoroughly to improve electrode contact and reduce irritation.
Position electrodes comfortably and avoid placing them too close together.
Turn the device on and begin with a low intensity setting. Gradually increase until a strong but comfortable tingling sensation is felt.
Use the device for the recommended session length, commonly 20–30 minutes, up to three times per day.
Power off the device before removing electrodes.
Clean electrodes after use and store them in a dry location.
These instructions are intended as general guidance. Always follow the manufacturer’s specific recommendations for your device, and consult with a healthcare provider before using TENS for headache or other conditions.
Commonly Used TENS Settings for Migraine
A frequently used configuration for migraine management aligns with conventional TENS parameters. This setting is commonly selected to emphasize sensory nerve stimulation.
Frequency: 100 Hz
Pulse Width: 200 microseconds
Intensity: Low
Duration: 20 minutes
The device referenced in this example is the TENS 7000, though similar settings may be available on other units.
If you’re unsure about electrode placement, settings, or whether a standard TENS unit is the right tool for your migraine pattern, working with a clinician experienced in headache care can make a meaningful difference.
👉 Explore how physical therapy can support migraine management Migraine Relief Through Physical Therapy
Precautions and Potential Side Effects
TENS is generally considered safe and well tolerated when used appropriately. However, individuals should be aware of possible side effects and precautions.
Potential side effects may include:
Skin irritation: Redness or irritation can occur with repeated use. Proper electrode placement and skin preparation can reduce this risk.
Allergic reactions: Some individuals may react to electrode materials or conductive gels. Discontinue use if itching, rash, or hives develop.
Muscle twitching: Excessive intensity or closely spaced electrodes may cause involuntary muscle contractions. Adjusting settings or placement can help.
Altered sensation: Tingling or mild numbness is expected during use, but discomfort should prompt adjustment.
TENS should not be used over or near implanted electronic medical devices such as pacemakers or defibrillators, as interference may occur.
When used correctly and with appropriate guidance, TENS remains a low-risk option for many individuals.
Conclusion
Neuromodulation devices represent a growing non-pharmacological option for managing migraine. TENS, in particular, offers a targeted, non-invasive approach that may support both short-term symptom relief and longer-term management for some individuals.
Migraine can significantly disrupt daily life, and while treatment approaches vary, TENS may be worth considering as part of a broader pain management strategy. Research suggests it can be effective for both migraine and tension-type headache in certain populations.
Anyone considering TENS should discuss its use with a qualified healthcare provider to ensure appropriate application and integration into an overall care plan.
About Me:
Hi, my name is Sam Kelokates, PT, DPT. I am a licensed physical therapist and owner of Kelos Physical Therapy located in Philadelphia, PA. I specialize in non-pharmacological management of headache and migraine disorders.
Affiliate Disclosure: As an Amazon Associate, I earn from qualifying purchases made through links in this article.
Educational Disclaimer: This content is intended for educational purposes only and does not constitute personalized medical advice. Individuals should seek care from a qualified healthcare professional for diagnosis and treatment.