Electricity has been used for headache since Roman times. In the first century AD, the black torpedo fish (electric ray) was (apparently successfully) applied to the pain. The 2 devices to recently come to the market in the US are the Cefaly (TENS) unit, and the Spring TMS Total Migraine System. Cefaly, from Belgium, is attached (usually daily) to the forehead for 20 minutes, as a preventive. The TMS unit is placed on the occiput (back of the head) for less than 1 minute, as an abortive for migraine.

The electric fish lost favor. Around 1900, with the introduction of electricity, several electric contraptions were used for pain and headache (among other conditions). They apparently also did not work. In 1986 the “PSL” TENS unit for headache was heavily promoted. Clinics were actually established just to use this device. Unfortunately, efficacy was minimal. A number of TENS units for headache have come and gone.

Cefaly: The Cefaly unit was first in Europe and Canada; the Cefaly available in those countries has several settings available, while in the US we only have one. Cefaly is a prescription in the US (non-prescription elsewhere). The strip is applied to the forehead once daily for 20 minutes, as a preventive. There was at least one positive controlled trial for Cefaly. Our results have been mediocre; some patients do like the Cefaly, but most have found it ineffective. In speaking with fellow headache specialists, the feeling is that Cefaly is slightly better than placebo, if at all. It is very safe, and may be used during pregnancy. The cost is $300 to $350. Insurance does not usually cover it.

Spring TMS: More promising is the TMS system from eNeura. Years of multi-center controlled trials have yielded positive results for TMS. The unit is applied (at home) to the occiput for a very short time. Several very quick magnetic pulses are delivered. The FDA indication is migraine with aura. As opposed to the 1 or 2 for headache, TMS for depression involves thousands of pulses at a sitting. TMS for depression has generally been very safe. For patients with uncontrolled epilepsy, TMS should not be utilized. TMS for headache is not readily available yet, but we expect it to be commercially available after January, 2015. The cost and insurance issues are unknown at this time. TMS will require a prescription, and the necessary SIM card will need to be periodically renewed by the patient.

Non-medication approaches for pain and headache are needed. TENS has been around for decades, with mixed results. The Cefaly TENS unit is safe, but efficacy is questionable. The more promising TMS unit, as a migraine abortive, may provide a viable alternative to drugs.

Lawrence Robbins, M.D.

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