Migraine Device Offers Drug-Free Relief for Vets, Study Says

A nonpharmacologic neuromodulation device may offer a migraine relief option to veterans for the complex, often service-related condition, a new study found. The majority (76.7%) of patients in the study were able to consistently manage their migraine attacks using remote electrical neuromodulation (REN) to stimulate fibers in the upper arm and trigger a pain inhibitory response that affects migraine and its associated symptoms.The study followed 466 veterans receiving Veterans Health Administration care over the course of 28,274 treatments between November 2020 and February 2026. Those veterans used the Nerivio REN device as a stand-alone therapy in 60.9% of treatments and paired it with an over-the-counter pain reliever in 15.8% of treatments. “We found that the device was safe, well tolerated, and effective for veterans, offering an alternative acute migraine treatment,” author Alan R. Towne, MD, MPH, director of the Headache Center of Excellence at Central Virginia Veterans Affairs Health Care System (CVVAHCS) in Richmond, told Federal Practitioner. “The safety profile was very good. In this study, there were only 2 patients who had any type of adverse event.”Adverse events involved transient arm pain or skin irritation related to the device worn on the arm much like a blood pressure cuff. “As you’re increasing the intensity of the device, you may feel some tingling, and some people reported that it was somewhat painful, but remember that you can turn it down,” Towne explained. “You can control the intensity of the device, so some of the patients just ramped it up too much.”The timing of REN device usage proved crucial: Veterans who started treatment within 1 hour of migraine onset had more benefit than those treated later. These patients experienced ≤ 28% higher rate of functional disability relief and were 83% more likely of achieving freedom from pain.A total of 66.7% of patients attained pain relief after 2 hours, while 26.6% achieved pain freedom after 2 hours. Meanwhile, 69.3% of patients reported relief from functional disability after 2 hours, and 33.3% noted complete freedom from functional disability.“There is an explosion of new ways to stimulate the brain for therapy,” Mark George, MD, editor-in-chief of Brain Stimulation: Basic, Translation and Clinical Research in Neuromodulation, explained. “This is just so exciting and dynamic. We’re in a discovery time.” George was not involved with the research.Veterans with migraines have a greater need to use different treatment modalities than many people in the general population. They have a higher likelihood of coexisting conditions, such as insomnia, chronic pain, mood disorders or a combination of these health issues, according to Karen Williams, a nurse practitioner who retired as deputy director for the CVVAHCS Headache Center of Excellence.Daily wear of military gear, along with mission-related exposures and trauma, can lead to musculoskeletal pain and injury. “Headache management in veterans is very complex. They usually don’t come in with just a migraine,” Williams noted. “Neuromodulation is a wonderful adjunctive therapy.” In 56.5% of patients, there was freedom from associated migraine symptoms, such as sensitivity to light and sound and nausea or vomiting after 2 hours.“This is an impressive accomplishment,” said Alan M. Rapoport, MD, clinical professor of neurology at the David Geffen School of Medicine at the University of California, Los Angeles. Rapoport called the fact that more than half of patients no longer had these symptoms in 2 hours after REN treatment “extraordinary.”Migraine affects about 14 to 15% of the global population, according to recent studies. However, in a study of 491,604 veterans, 8.2% of men and 30.1% of women reported a history of migraine (due the condition being much more common in females).Nerivio is 1 of 4 migraine devices available through VA, said Dana L. Ionel, DO, assistant professor of headache neurology and program director of the headache medicine fellowship at the University of Kentucky.Ionel, who has been working with veterans since 2018 and regularly prescribing neuromodulation devices in this population since 2023, said the study is “a great step in showing that we can help manage pain and disability without necessarily needing to add more medicines.”“This is especially important in our patients who may be older or already taking a lot of medicines for other conditions,” she said.