Can Electrical Nerve Stimulation Treat Migraine?

Transcutaneous electrical nerve stimulation (TENS) is a preventive and acute migraine treatment that uses electrical pulses to stimulate nerves and reduce pain. Here’s how it works.

As we learn more about migraine, researchers and doctors are also testing and developing new methods of treatment.

Transcutaneous electrical nerve stimulation (TENS) is one newer form of preventive and acute migraine treatment. It works by sending electrical currents through the skin to stimulate particular nerves in the body.

Here’s a breakdown of what TENS is, how it works, and the different types of treatment currently available in the United States for people with migraine.

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What is transcutaneous electrical nerve stimulation (TENS)?

TENS is a method of pain relief that can be used to provide relief for a range of pain-related conditions, including arthritis, endometriosis, and migraine.

TENS uses a small device to send mild electrical pulses to specific parts of the body. These electrical currents activate nerves and neurotransmitters to decrease or block the perception of pain. There are a few different types of TENS treatments, and each targets different nerves.

TENS treatment is “transcutaneous,” meaning the device goes onto your skin but doesn’t pierce it. This is different from other forms of electrical nerve stimulation, which can require surgery to implant a device inside the body.

Instead, a TENS user places sticky electrodes on their body, and pulses pass through intact skin.

TENS has relatively few side effects. Some people may not experience any, while others may experience things like:

• sleepiness
• mild or moderate skin irritation, reactions, or allergies at the site of electrodes
• sensations of buzzing, prickling, or tingling (paresthesia)
• mild or moderate muscle contractions in the muscles around the electrodes

How does TENS work?

Scientists are still investigating exactly how TENS reduces pain. There are likely a few different mechanisms involved.

According to 2023 research, electrical currents may activate particular nerves that reduce or even block pain receptors from sending pain signals to the brain.

Research from 2021 notes that electrical currents modulate neurotransmitter activity, regulating feel-good chemical messengers like serotonin and dopamine.

Older 2014 research suggests electrical currents increase the level of endorphins, a group of neurotransmitters that act as natural pain relievers.

How do you use a TENS device?

To use a TENS device, the user first places electrodes on specific areas of the body, depending on the type of treatment and the nerves targeted. Electrodes should only be placed on healthy skin free of cuts or rashes.

Then, the user activates the device to begin treatment. A single session generally ranges from a few minutes to about an hour. Some devices have a pre-programmed session duration and will turn off automatically, but users can stop treatment at any point.

Depending on the TENS device, users may be able to control:

• intensity or how strong the electrical current is
• frequency or the number of electrical pulses per second
• pulse duration or how many microseconds a single pulse lasts

When the session is over, the user removes the electrodes.

Is TENS an effective migraine treatment?

TENS has been used for some time to treat other conditions, but using this method for migraine and headache pain is relatively new.

This wide-ranging 2021 systematic review examined clinical trials conducted on different types of TENS treatment for people with chronic migraine, reporting that nearly all the studies found TENS to be beneficial.

Benefits included:

• decreases in pain during migraine attacks
• decreases in the severity of migraine attacks
• fewer headache days per month

What are the types of TENS migraine treatments?

There are multiple types of treatments under the TENS migraine treatment umbrella, all of which target different nerves.

Treatments include:

• vagus nerve stimulation (VNS)
• trigeminal nerve stimulation (TNS)
• transcutaneous occipital nerve stimulation (TONS)

All of these treatments can be used during an attack or as preventive treatments on a regular basis.

Vagus nerve stimulation (VNS)

The vagus nerve runs from the brain down the sides of the neck and into the large intestine. It helps control functions like taste, digestion, speech, and mood. VNS stimulates the vagus nerve through the neck.

Research from 2023 shows that this stimulation may regulate neurotransmitters. Research from 2018 notes VNS inhibits cortical spreading depression, which is partly responsible for migraine and migraine aura.

Trigeminal nerve stimulation (TNS)

The trigeminal nerve communicates sensory information like touch, pain, and temperature and helps control functions like chewing.

TNS stimulates the trigeminal nerve pair through your forehead. It’s unclear exactly how stimulating this nerve helps with migraine, but 2019 research indicates that using TNS during an attack may reduce the perception of pain by blocking pain transmission to the brain.

Transcutaneous occipital nerve stimulation (TONS)

The occipital nerves are a group of nerves at the back of your head that run from your head into your neck and connect with spinal nerves. Occipital nerves provide sensation to the top and back of your head.

TONS stimulates the occipital nerves from behind your head. Research into its mechanisms is ongoing, but 2017 research suggests that this stimulation may help block the transmission of pain signals to the brain.

Can VNS, TNS, and TONS treat migraine?

Research into the different forms of TENS treatment is ongoing, but the results are promising.

A 2023 systematic review examined studies on VNS for the prevention and acute relief of chronic and episodic migraine. It found that this method of treatment reduced headache intensity and lowered the number of headache days per month.

A 2018 study on VNS for acute relief found that treatment effectively stopped an attack up to 60 minutes after headache onset. It also found that rates of pain relief from VNS 2 hours after headache onset were similar to those found in studies evaluating triptans for acute relief.

A 2019 study on TNS for acute relief found that 1-hour treatment provided effective pain relief to participants experiencing a migraine attack, even when users started treatment late into the attack.

The study also reported that pain reduction using TNS was greater than pain reduction using standard acute treatments like sumatriptan and diclofenac, a prescription NSAID. However, it also underlined that more research is needed to better compare various TENS methods with existing migraine medication.

A 2017 study on TONS for acute relief and migraine prevention found that treatment was effective at reducing headache pain, intensity, and duration during a migraine attack. Treatment also lowered the number of headache days per month.

The study also compared TONS with the migraine prevention medication topiramate. It concluded that the effectiveness of treatment with TONS is comparable to treatment with topiramate.

Pros and cons of using TENS for migraine relief

Transcutaneous electrical nerve stimulation, including VNS, TNS, and TONS, may be able to offer new forms of treatment to people with chronic and episodic migraine.

Like with any medical treatment, TENS may work well for some people and not as well for others.

Here are some of the pros of TENS treatment:

• few side effects
• can be used in combination with many other medications and pain relievers without risk of interactions
• can be used frequently without the risk of overuse, dependence, or rebound headache
• offers an alternative treatment for people who have reactions to oral medication or who can’t use medication for health reasons
• small, portable, and easy to use

Here are some of the cons of TENS treatment:

• not always covered by insurance
• electrodes need to be replaced after a certain number of uses
• some may not like the sensation of electrical pulses, especially during migraine episodes

Some people can’t use TENS, including those who have:

• a pacemaker, defibrillator, or other electrical or metal implants
• a heart condition
• cancer
• epilepsy

Research is also ongoing regarding TENS use during pregnancy. Consult with a doctor before using a TENS device if you’re pregnant or planning to become pregnant.

What TENS devices are currently available?

Multiple TENS devices are FDA-cleared for migraine treatment and prevention, including:

• gammaCore, a VNS device
• Cefaly, a TNS device
• Relivion, a combination TNS-TONS device

Some devices require a prescription, but not all.

Other TENS devices exist but haven’t been specifically designed or cleared for migraine and headache treatment.

The takeaway

Transcutaneous electrical nerve stimulation (TENS) is a new form of preventive and acute treatment for migraine, using electrical currents to stimulate nerves and relieve pain. Research indicates that TENS can effectively treat and prevent migraine.

If you’re interested in exploring TENS treatment for migraine, consider talking with a doctor to understand whether it’s safe for your body and determine which treatment is most appropriate for you.