Migraine disease is a condition that causes recurring headaches, which can be very painful and often come with other symptoms. Migraine is actually more than just a headache - it's a neurological condition that affects the brain AND the body.
During a migraine attack someone may experience moderate to severe headache pain, that is described as pulsating or throbbing. They will also expeience nausea and/or vomiting, and sensitivity to light and sound.
Migraine attacks can last anywhere from a few hours to a few days, and can be very debilitating for many people. In some cases an attack can be relentless, known as status migrainosus.
There are many different treatments available for migraine, both to prevent attacks and to manage them when they do occur. Treatment options can include lifestyle changes, medications, and alternative therapies.
While pharmacological treatments can be effective for many people with migraine, there are many shortcomings to relying solely on medication for treatments. Medications like triptans and NSAIDS can be effective for many people, but they don’t work for everyone with migraine.
In fact, one study reported that triptans were insufficient or intolerable for 30-40% patients. This leaves many unable to benefit from migraine-specific medications!
Also, most medications come with unwanted side effects that can affect one’s day to day function. The most commonly reported side effects are difficulty concentrating and confusion, weight gain, excessive fatigue, and mood changes. Sometimes these side effects are worse than migraine itself!
Given these shortcomings, it’s important to explore alternative treatments in addition to pharmacological treatments. Transcutaneous Electrical Nerve Stimulator (TENS) devices can be good alternatives to pharmaceuticals. Here are a few reasons why.
Benefits of using TENS for Migraine
TENS devices have fewer side effects than pharmaceuticals. Medications can cause a variety of side effects, such as dizziness, nausea, and drowsiness, which can be bothersome or even dangerous. Neuromodulation devices, on the other hand, work by stimulating sensory and/or motor nerves. This means they can be effective without the side effects associated with drugs.
TENS offer targeted therapy that can be customized to each individual's needs. Many medications have a broad impact on the body, affecting not just the targeted symptoms but also other body systems. The electrodes for these devices, on the other hand, can be specifically placed to the area of the body that needs treatment. This means we can be more precise and effective, and can avoid unwanted effects on other parts of the body.
TENS, as well as other neuromodulation devices, are non-addictive. They do not create a dependence or a risk of abuse with use. Many medications used for chronic pain or neurological conditions are addictive or can cause dependency, and may require weaning when stopping. Neuromodulation devices do not carry this risk, making them a safer option for many people.
These devices can provide long-term relief for episodic and chronic migraine. Medications, on the other hand, may need to be taken daily, may lose their effectiveness over time, and may make you feel even worsen than when not taking them.
TENS devices can offer relief for months without the need for frequent adjustment.
How Does TENS Work for Migraine
Diferent Modes for TENS Stimulation
How does TENS work for migraine?
Transcutaneous Electrical Nerve Stimulation, which is a non-invasive therapy that uses low-voltage electrical currents to block migraine pain. It works by sending small electrical impulses through electrodes that are placed on the skin near the area of pain, or over nerves implicated in migraine pathophysiology.
These electrical impulses are believed to stimulate the sensory nerves and block pain signals from reaching the brain, by creating a paresthesia (numbness) over the area. TENS may also stimulate the production of endorphins, which are the body's natural painkillers, providing additional pain relief.
TENS units have various settings: frequency, intensity, and pulse duration. These can be adjusted to customize the treatment to your needs and tolerance level. TENS can also be used to treat neck, shoulder, and jaw pain that may accompany migraine.
Theory of how TENS treats Migraine
The Gate Control Theory of Pain suggests that pain is not simply a result of tissue damage or injury, but is also influenced by how the brain processes and interprets pain signals. The theory proposes that the spinal cord contains a "gate" that can either allow or block pain signals from reaching the brain.
This is where TENS comes in. By stimulating the sensory nerves, TENS can effectively close the gate and reduce the transmission of pain signals to the brain. This makes TENS a useful non-pharmacological treatment option for managing episode and chronic migraine, as well as tension-type and cervicogenic headache.
Different Modes of TENS Stimulation
There are several different modes of TENS that can be used for pain management. The choice of mode may depend on the type and location of pain, as well as the individual's response to treatment. Here are some of the most commonly used modes of TENS:
Conventional TENS: This mode uses a high frequency (50-100 Hz), 50-200 μs pulse width, and low intensity (below the motor threshold) stimulation to provide temporary pain relief by stimulating the sensory nerves. Resulting in paresthesia or numbness of the area
Burst TENS: This mode delivers short bursts of high-frequency stimulation followed by periods of no stimulation. This can be an alternative mode for individuals who do not respond well to conventional TENS.
Modulation TENS: This mode alternates between high and low frequency stimulation to prevent the body from adapting to the same stimulation over time. In theory, providing longer-lasting pain relief.
Acupuncture-like TENS: This mode uses a low-frequency (2-4 Hz), high pulse width (100-400 μs), high intensity stimulation that is similar to traditional acupuncture, which may be effective in managing chronic pain.
Brief intense TENS: This mode delivers a high-intensity stimulation for a brief period of time (typically 30-60 seconds, no more than 5 minutes), which can provide quick relief for acute pain.
In regards to migraine specific research for TENS, most studies use parameters that would be considered Conventional TENS. This is because the intention of these parameters is to selectively stimulate the sensory nerves related to migraine pain.
It's always recommended to consult with a healthcare provider to determine the most appropriate mode of TENS for individual pain management needs. It's important to note that the effectiveness of TENS and the choice of mode may vary from person to person.
The Effectiveness of TENS for Migraine
Transcutaneous nerve stimulation (TENS) for the PREVENTATIVE treatment of migraine was recently reviewed by Evans et al. in 2022. A total of 995 participants across 14 trials were examined by the authors. The articles included both controlled and uncontrolled trials, seven each.
The findings revealed that TENS was effective at reducing headache frequency in both chronic and episodic migraine patients. Those with episodic migraine had a reduction of 2.81 days per month. Chronic migraine had a reduction of 2.97 headache days per month.
The results of the study indicate that TENS is a promising non-pharmacological alternative for the treatment of migraine headaches. TENS was additionally discovered to be secure and well-tolerated by the participants.
TENS has also been used as an ACUTE treatment for migraine in several studies. In one randomized controlled trial authors evaluated the effectiveness of transcutaneous electrical nerve stimulation (TENS) for treating migraine attacks in the emergency department.
The study by Hokenek et al in 2021, involved 39 participants in both the treatment and placebo groups. Participants were randomly assigned to either the TENS or placebo group. Treatment with the TENS device lasted 20 minutes.
The treatment group experienced a significant improvement in pain from the start of the 20-minute treatment, and pain continued to improve up to 120 minutes after initiation of the TENS device.
This study demonstrated that an acute migraine attack can be effectively treated by TENS, and deliver pain relief within minutes of application!
Overall, these studies suggest that TENS may be an effective preventative and acute, non-pharmacological, treatment option for migraine.
How to apply TENS for Migraine
Below I will give instructions of placement of TENS electrodes. I will provide pictures for electrode locations over the occipital nerves and the supraorbital nerves. These are common areas of focus in many studies evaluating TENS efficacy for migraine treatment.
The supraorbital nerves are located in the forehead directly above the midline of the eye. The occipital nerves can be found at the base of the skull. Usually at the bottom of the hairline of the neck for most people.
Here are general instructions on how to properly apply TENS:
Make sure the TENS device is turned off before placing the electrodes.
Locate the specific area (supraorbital nerve or occipital nerve) where you want to apply the TENS.
Clean the skin in the area where you will be placing the electrodes. This will help to ensure good contact between the skin and the electrodes.
Make sure the electrodes are placed in a comfortable position and that they are not too close together, as this can cause discomfort or skin irritation.
Turn on the TENS device and adjust the settings according to the instructions provided with the device. It is important to start with a low intensity setting and gradually increase it until you feel a comfortable, but strong, tingling sensation.
Continue using the TENS device for the recommended duration, which is typically 20-30 minutes per session, up to three times per day.
When you are finished, turn off the TENS device and remove the electrodes.
Clean the electrodes with a damp cloth and store them in a dry place.
Note that these are general instructions and it's important to follow the specific instructions provided with your TENS device. Additionally, it's important to consult with your healthcare provider before using TENS for headache or any other condition.
The most common setting I use for myself, as well as many patients, is within the setting range for Conventional TENS:
Frequency: 100 hz
Pulse Width: 200μs
Duration: 20 minutes
The device I use is the TENS 7000**
Precautions and potential side effects
Transcutaneous Electrical Nerve Stimulation (TENS) is generally considered safe and well-tolerated when properly administered. However, there are some potential side effects that individuals should be aware of. Here are some of the potential side effects of TENS:
Skin irritation: Prolonged or repeated use of TENS may cause skin irritation or redness at the site of electrode placement. It is important to follow the instructions for electrode placement and use appropriate conductive gel to minimize skin irritation.
Allergic reaction: Some individuals may have an allergic reaction to the conductive gel used with TENS or to the materials used to make the electrodes. If you experience itching, rash, or hives after using TENS, discontinue use and consult your healthcare provider.
Muscle twitching: TENS can cause involuntary muscle contractions or twitching, especially if the intensity is set too high or if the electrodes are placed too close together. Adjusting the intensity or electrode placement can help reduce muscle twitching.
Numbness or tingling: TENS may cause numbness or tingling sensations in the area being treated. This is a normal and expected sensation when using TENS, but if it becomes uncomfortable or painful, adjust the intensity or electrode placement.
Interference with implanted devices: TENS should NOT be used near or over implanted devices such as pacemakers, defibrillators, or other electronic medical devices, as it may interfere with their function.
Overall, TENS is a safe and effective treatment option for many individuals. However, it is important to be aware of the potential side effects and to follow the instructions provided with the TENS device to minimize the risk of adverse effects.
Overall, neuromodulation devices offer a promising alternative to pharmaceuticals for the treatment of chronic migraine. TENS can be effective, precise, safe, and provide long-term relief for many individuals.
If you suffer from migraine, you know how debilitating and disruptive they can be to your daily life. While there are many treatments available for these conditions, you may want to consider transcutaneous electrical nerve stimulation (TENS) as a potential treatment option.
TENS is a safe and non-invasive treatment that uses low-level electrical currents to stimulate the nerves and reduce pain. Many studies have shown that TENS can be an effective treatment option for migraine and tension headaches, providing relief for many individuals.
If you're interested in exploring TENS as a treatment option, talk to your healthcare provider. They can help you determine if TENS is right for you and provide guidance on how to properly use the device.
Don't let migraine or tension headaches control your life. Consider TENS as a potential treatment option and take control of your pain management today
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**This is not personalized medical advice. The content is intended as educational content. If you are a patient, seek the care of a health care professional.**
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.