Compared to other types of migraines, menstrual migraines do not always respond well to the typical treatments, such as medication.
To address the treatment gap, researchers have been evaluating a wearable device called Nerivio, which uses a drug-free pain relief method called remote electrical neuromodulation (REN).
What Are Menstrual Migraines?
Migraine symptoms related to the menstrual cycle are common, affecting over 50% of people who menstruate. Hida del Carmen Nierenburg, MD, a neurologist and headache specialist with Nuvance Health, tells Verywell that a person who experiences menstrual migraines gets migraines during menstruation as well as at other times of the month.
Menstrual migraines are thought to be triggered by the sudden decrease in estrogen levels that occurs right before menstruation begins.
“Menstrual migraines tend to be tougher to treat, and the pain is more severe, for unclear reasons,” says Nierenburg. “The way we treat menstrual migraines is sometimes with birth control (oral contraceptives), but the studies are outdated. There’s very little adequate or recent research evidence supporting effectiveness, and for some women, oral contraceptives can make migraines worse.”
Some people with menstrual migraines manage their symptoms through “mini-prophylaxis” with non-steroidal anti-inflammatory medications (NSAIDs) and triptans (the standard acute treatment for migraine), which they take for several days during the expected attack.
However, some people cannot use this method because of medication side effects and allergies to NSAIDs. Non-medication alternatives are needed for these people as well as for people for whom these treatments have not been successful.
What Is Nerivio?
Nerivio is the only device with remote electrical neuromodulation (REN) that has been cleared by the U.S. Food and Drug Administration (FDA) for the acute treatment of migraine. It works by a mechanism called conditioned pain modulation (CPM).
The device applies an electrical stimulus to the upper arm. It is not painful for the wearer, but the signal “tricks” the nerves in the arm into perceiving the sensation of pain.
This, in turn, causes the pain centers in the brainstem to become activated. When this happens, the brain stem releases neurotransmitters—such as norepinephrine and serotonin—to help relieve the pain.
What Does the Research Say?
The researchers gathered information from a retrospective survey that included 91 women between the ages of 18 to 55 who experienced migraines around the time of their menstrual cycle.
Of these women, 68 women (75%) reported at least a moderate relief of their migraine symptoms while they were wearing the REN unit.
The researchers also found that two-thirds of other migraine patients also experienced pain relief after two hours of using Nerivio.
Minimal Side Effects and Risks
Another advantage to REN is that it has minimal side effects. In the trial, 12 of the 91 people who used Nerivio reported mild side effects such as bruising on their arm where they had been wearing the device, nausea, and dizziness.
The device also does not have the potential to interact with other medications that a user might be taking because it is a drug-free pain relief method.
“Migraine patients are sensitive to overuse of rescue medications," says Nierenburg. “Taking triptans or over-the-counter medications such as combination analgesics with acetaminophen and caffeine more than 10 days a month can cause them to have more headaches.”
Who Else Could Nerivio Help?
People who used REN therapy to treat their menstrual migraines also reported a decrease in other menstrual-related pain, including cramps (38% decrease) and pelvic pain (37% decrease).
These findings have led the researchers to believe that REN therapy could also be helpful for other types of chronic pain that are difficult to treat with medication.
Using the protocol created for the research, Nierenburg has also successfully treated patients with chronic migraines that are tough to manage.
Nerivio might potentially be used for other types of pain in the future, but Nierenburg says that other indications for the treatment have not been studied yet.
It’s clear that there are benefits to using a drug-free pain relief method like Nerivio that go beyond efficacy; Nierenburg points out that for patients who need pain relief without the sedation that can come with some treatments (such as people who drive for a living or operate heavy machinery), a device like Nerivio could be a good option.
Pregnant patients with pain relief needs can also present management challenges for doctors, as they are limited by what medications they can prescribe. Again, Nierenburg says that an option like Nerivio could meet those patients’ needs.
