Migraines affect about 39 million Americans, yet many who suffer from them feel their symptoms are dismissed or downplayed by their health-care providers. Part of the problem is that the illness remains poorly understood even among medical professionals. Migraine is a brain disorder that causes your neurons (i.e., the nerves in your brain) to become “hyperactive,” explains Cynthia Armand, MD, a migraine specialist for the Montefiore Health System in New York City. It can cause one-sided, often debilitating head pain that lasts up to 72 hours and may be accompanied by nausea, vomiting, and sensitivity to light and sound. “It greatly impacts quality of life, since attacks often lead to inability to engage in physical activity,” says Dr. Armand.
Despite the prevalence of the illness, there are only about 500 headache specialists in the United States, and there’s been a lack of funding for research into causes and treatment, according to the Migraine Research Foundation. “For a long time, there wasn’t a lot of action in the headache therapy arena,” says Stewart Tepper, MD, a headache specialist and professor of neurology at Dartmouth Geisel School of Medicine.
Fortunately for those who suffer from migraines, an explosion of new technologies and treatments is disrupting the migraine space. “The past several years have been the headiest years of my professional career, and I’ve been a headache-medicine doctor since the Ronald Reagan administration,” says Dr. Tepper. First, Americans have more access to specialized care thanks to telehealth sites that connect them with providers and offer easier access to migraine treatments. Second, the treatments themselves have advanced, with several new non-drug options in the form of neuromodulation devices.
Read on to take a closer look at how migraine care is changing—for the better.
Telemedicine for migraines
Waitlists to see a headache specialist can be months long in many parts of the country, and specialized care isn’t always covered by medical insurance. Add in the current social-distancing recommendations and it becomes even harder to see a specialist and fill prescriptions. But two telemedicine companies aim to help:
Primary care physicians treat the majority of migraine patients, but they don’t always have the time or specialized training to develop personalized treatment plans. “Cove brings the specialist experience online, making it easy to connect with an experienced doctor on the patient’s schedule,” says Caroline Hoffman, general manager of the migraine startup Cove.
Cove also offers access to prescription-only migraine medications—including those that help to prevent or reduce the severity of attacks or manage other symptoms—medical devices, and supplements that can help.
To get started, you’ll complete an online questionnaire, then consult with a health-care provider to receive a tailored treatment plan. The prescriptions are then delivered to you by mail in about a week and refilled as necessary.
The program doesn’t accept insurance, but it only costs $4 a month for unlimited texts with one of their staff doctors, plus the price of your medication (from about $10 to $40 per month for generic prescriptions).
Nurx was founded in 2015 to offer affordable health care for women and people with uteruses—specifically, access to birth control, emergency contraception, and at-home STI screenings via telemedicine. In September, the startup also began offering migraine treatment, and it now provides access to nine different generic prescriptions that help to treat or prevent migraines. Since the majority of migraine sufferers are women, “we felt that we were uniquely positioned to address one of the most common health conditions,” says Allison Hoffman, the head of communications for Nurx.
Nurx first requires patients to take a video exam, which helps the company’s medical team formulate a treatment plan or determine if you should seek in-person care for a more serious health condition. Next, you enter your insurance info, if you have it, then your file will be reviewed by a doctor. If they write you a prescription, Nurx will fill it, ship it to you, and automatically refill it as needed.
One year on the platform costs $60, which includes consultations with a doctor. If you have insurance, Nurx bills your provider for the medication; you’ll just owe your insurance copayment. Without insurance, medications cost anywhere from $25- $70 per month.
Better treatment on the horizon: neuromodulation for migraines
A 2017 study of more than 15,000 Americans with migraines found that nearly all of those who used an oral medication to treat their headaches had at least one unmet treatment need. (Meaning: Oral medications are helpful, but don't solve for all migraine symptoms.) Neuromodulation therapy administered by a medical device may be able to help fill some of those unmet needs by helping to reduce the severity and/or frequency of migraine attacks.
The devices all work differently, but in general, they use magnets or electricity to modulate the activity of the nervous system. It's a relatively new form of treatment that studies have shown to be fairly promising, especially for people with chronic migraines—but more robust research is needed. The upsides of this type of treatment are that it can help those who aren’t able to (or don’t want to) take medications, and there is minimal risk for side effects. (Dr. Armand notes you shouldn’t use neuromodulation if you have a metal or electronic implant in your body, a pacemaker or defibrillator, or if you have seizures or certain types of heart disease.) The downsides are that most of the devices require prescriptions, doctors who are not headache specialists may not be familiar with the devices or suggest them to their patients, and the cost (which tends to be more expensive than medication) isn’t usually covered by health insurance.
With those nuances in mind, here’s a closer look at a few of the newest devices:
This remote electrical neuromodulation (REN) wearable device only reduces pain once you’re having a migraine. You’ll wear a disposable armband that induces conditioned pain modulation: For about 45 minutes, it will deliver an electrical signal to one area of your body (your arm) that, in essence, tricks your nervous system into reducing pain in another area (your head). The band is paired with an app, and it lets you adjust the level of the electronic signal to find what works (Dr. Tepper says patients may feel a buzzing sensation, but it shouldn’t hurt). Each device costs about $100, and treats 12 migraines. Some good news: Cove prescribes the device—and offers a discount—to its members.
This small external trigeminal nerve stimulation (eTNS) device attaches to your forehead and sends electrical stimulation via the ophthalmic nerve to pain regulatory pathways in your brain; it’s thought to work by putting an inhibitory signal on the pain pathway. For preventative benefits, you wear it for 20 minutes every night for three months. It can also be used for an hour at the onset of a migraine to reduce the intensity of pain. The device costs about $400, and the electrodes are reusable up to 20 times (new electrodes cost $25 for a three-pack).
The GammaCore Sapphire is a handheld device designed to stimulate the vagus nerve, one of the longest nerves that helps regulate crucial bodily functions, like heart rate, digestion, and breathing. When you hold the GammaCore over the area of your neck area where the vagus nerve is located for two to three minutes, it sends electrical stimulation to the brain to inhibit pain signals. With a prescription, you can lease the device for about $600 a month (each month you need to pay the fee again to reactivate it with a code).
These are just a few of the current device offerings, and there are new ones in the works (for example, ShiraTronics, a medical device accelerator is working on new neuromodulation technologies and has raised a total of $36 million in funding to date). Hopefully, they’ll become more widely available and prices will come down in the future.
But for now, migraine treatment is at least moving in the right direction. “It’s just astonishing,” Dr. Tepper says. “I can’t even count the number of patients who have said their lives have been changed in the last couple of years.” Now, let’s hope that momentum continues.
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