The central theses
- Research shows that in 50% of people who suffer from migraines and menstruation, the hormonal changes associated with menstruation can be a migraine trigger.
- Menstrual migraines can be difficult to manage because the symptoms may not respond to the drugs used to treat other types of migraines.
- A new technology called Remote Electric Neuromodulation (REN) has been shown to be effective in treating other types of migraines. Now researchers say the device can also provide non-drug relief from symptoms of menstrual-related migraines.
Finding an effective treatment can be difficult for people with migraines, which are caused by the hormonal changes around their menstrual cycle. Menstrual migraines affect 60% of people who have regular migraine headaches and get menstrual periods.
Compared to other types of migraines, menstrual migraines do not always respond well to typical treatments such as medication.
To fill the treatment gap, researchers evaluated a wearable device called the Nerivio, which uses a drug-free pain relief method called Remote Electric Neuromodulation (REN).
What are menstrual migraines?
Menstrual cycle-related migraine symptoms are common and affect over 50% of people who menstruate. Hida del Carmen Kidneyburg, MD, neurologist and headache specialist at Nuvance Health, says Verywell that a person suffering from menstrual migraines gets migraines during menstruation as well as at other times of the month.
It is believed that menstrual migraines are triggered by the sudden drop in estrogen levels that occurs just before menstruation begins.
Pure menstrual migraines (which only occur during menstruation) are rare, affecting only about 12% of people who menstruate. These migraines occur anywhere from two days before to three days after a person’s menstruation.
“Menstrual migraines are usually more difficult to treat and the pain is more severe for some unclear reason,” says Kidneyburg. “We sometimes use contraceptives (oral contraceptives) to treat menstrual migraines, but the studies are out of date. There is very little adequate or current research to demonstrate its effectiveness, and in some women, oral contraceptives can make migraines worse. ”
Menstrual migraines may not respond to the medications typically used for migraine headaches – and it’s not clear why.
Some people with menstrual migraines treat their symptoms with “mini-prophylaxis” with non-steroidal anti-inflammatory drugs (NSAIDs) and triptans (the standard acute treatment for migraines) that they take for several days during the expected attack.
However, some people cannot use this method because of drug side effects and allergies to NSAIDs. Medicinal alternatives are needed for both these people and those for whom these treatments have not been successful.
What is Nerivio?
Nerivio is the only remote electrical neuromodulation (REN) device approved by the U.S. Food and Drug Administration (FDA) for the acute management of migraines. It works by a mechanism called conditioned pain modulation (CPM).
How does Nerivio work?
Nerivio is a small, discreet REN device. Users wear it around their upper arm for migraine pain relief when needed. You can control the device via Bluetooth and the associated smartphone app.
The device applies an electrical stimulus to the upper arm. It is not painful for the wearer, but the signal “trickes” the nerves in the arm into perceiving the sensation of pain.
This activates the pain centers in the brain stem. When this happens, the brainstem releases neurotransmitters like norepinephrine and serotonin to help ease the pain.
What does the research say?
The researchers gathered information from a retrospective survey of 91 women between the ages of 18 and 55 who suffered from migraines during their menstrual cycle.
Of these women, 68 women (75%) reported at least moderate relief from their migraine symptoms while wearing the REN unit.
The researchers also found that two-thirds of other migraine sufferers also experienced pain relief after using Nerivio for two hours.
Research has shown that REN can be a safe and effective treatment for adolescents with migraines, and may even work better than standard treatments. Nerivio has been approved by the FDA for use in adolescents.
Minimal side effects and risks
Another benefit of REN is that it has minimal side effects. In the study, 12 of the 91 people who used Nerivio reported mild side effects such as bruising on the arm where they were wearing the device, nausea and dizziness.
The device also does not have the potential to interact with any other medication a user may be taking, as it is a drug-free method of pain relief.
“Migraineurs are sensitive to the excessive use of emergency medication,” says Kidneyburg. “Taking triptans or over-the-counter drugs such as combination analgesics with paracetamol and caffeine for more than 10 days a month can result in more headaches.”
Who else could Nerivio help?
People who used REN therapy to treat their menstrual migraines also reported decreases in other menstrual-related pain, including cramps (38% decrease) and pelvic pain (37% decrease).
These results 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.
With the protocol created for the research, Kidneyburg has also successfully treated patients with difficult-to-treat chronic migraines.
Nerivio could potentially be used for other types of pain in the future, but Kidneyburg says other indications for the treatment have not yet been studied.
It is clear that using a drug-free pain relief method like Nerivio has benefits that go beyond effectiveness. Kidneyburg suggests that for patients who need pain relief without the sedation that some treatments may provide (e.g., people who drive a car or operate heavy machinery), a device like Nerivio may be a good option could.
Pregnant patients in need of pain relief can also be a management challenge for doctors as they are limited by the drugs they can prescribe. Here, too, Kidneyburg says an option like Nerivio could meet these patients’ needs.
What that means for you
Nerivio is available on prescription from a specialty pharmacy and is covered by some insurance plans. If you’re having trouble managing your symptoms, ask your migraine specialist if a REN machine like Nerivio could help you.