Survey results show the effectiveness of REN in menstrual migraines

Remote electrical neuromodulation (REN) could be a safe and effective non-pharmacological treatment option for patients with menstrual migraines, according to the results of the study published in Pain and Therapy.

About 60% of female migraineurs suffer from menstrual seizures, and menstrual migraines are often more painful, more disabling, of longer duration, and less responsive to treatment, the authors write.

In addition, “pharmacotherapy for menstrual migraines is made even more complicated by the lack of strong evidence-based recommendations, the involvement of hormones and, in some cases, the use of contraception,” they said.

Both European and American headache associations recommend integrating neuromodulation into migraine management for certain patients, and previous research has shown that REN is safe and clinically beneficial for treating adults with episodic or chronic migraines.

Abortive treatment in particular “mainly stimulates C and Aδ fibers in the upper arm to activate an endogenous analgesic mechanism known as conditioned pain modulation (CPM)”.

To better understand the effectiveness, satisfaction, and safety of REN in women using the treatment as part of their regular migraine treatment, the researchers conducted an online survey of users.

All participants (n = 91) used Nerivio, a device from Theranica Bio-Electronics Ltd, and were recruited via in-app notification and / or email. Patients were between 18 and 55 years old, lived in the United States, and had at least 4 treatment sessions between October 2019 and October 2020.

Menstrual migraines were defined as an affirmative answer to the prompt: “Do you usually have migraines that occur 2 days before your period or during the first 3 days of your period (menstrual migraines)?” All participants were also prescribed migraine therapy by a neurologist.

The majority of women were white (92%) with a mean age of about 35 years and an average of 13 headache days per month. Of the migraine sufferers included, “88 (96.7%) women had a menstrual-related migraine (seizures occur primarily, but not only during the perimenstrual period) and 3 women (3.3%) had a purely menstrual migraine (seizures only occur during menstruation), ”the researchers wrote – a ratio that is consistent with the relative ratio of women with purely menstrual migraines in epidemiological studies.

Analyzes showed:

  • 74.7% (68/91) said the treatment was at least moderately effective (moderately effective 37.4%; very effective 26.4%; extremely effective 11%).
  • 45.1% (41/91) stated that they were satisfied with REN (somewhat satisfied, 33%; extremely satisfied, 12.1%), while 34.1% were neutral and 20.9% (19/91) were not were satisfied.
  • 100% of the participants stated that the treatment was at least moderately well tolerated (moderately well tolerated, 8.8%; very well tolerated, 20.9%; extremely well tolerated, 70.3%).
  • 13.2% (12/91) of the respondents reported slight short-term side effects.
  • 61.3% (46/75) of participants reported that the treatment was ineffective for convulsions (weakly effective, 29.3%; ineffective, 32.2%).
  • 63.2% (24/38) of participants reported that the treatment was ineffective for pelvic pain (slightly effective, 28.9%; ineffective, 34.2%).

Side effects reported included a sore arm several days after treatment, a bruised arm, nausea, dizziness, lightheadedness, muscle twitching, numbness in the arms during treatment, and tingling in the arm and hand.

“This study gives hope to the many women whose migraines are linked to menstruation,” said Hida Kidneyburg, MD, lead author of the study. “This can be a particularly important option for women who are taking other medications and who may be at risk for drug interactions.”

The retrospective self-reporting nature of the study is a limitation as it can introduce memory bias. The results may not be generalizable to non-REN users, and clinical studies are warranted to better understand the effects of the treatment.


Kidney Castle H, Rabany L, Lin T, et al. Electrical remote neuromodulation (REN) for the acute treatment of menstrual migraines: a retrospective overview study of efficacy and tolerability. Pain there. Published online June 17, 2021. doi: 10.1007 / s40122-021-00276-7