Neuromodulation uses gentle electrical, magnetic or light energy to influence nerve activity. The American Headache Society notes these options may be appropriate for prevention and acute treatment, especially for people who prefer non-drug options or do not tolerate medication ¹.

Vagus nerve stimulation (VNS)

The vagus nerve is the main “rest and digest” nerve. Non-invasive devices stimulate it through the neck or ear.

• In the PRESTO trial, non-invasive VNS during attacks helped more people become pain-free than a sham device ².
• It has also been studied for preventing chronic migraine ³.
• A recent meta-analysis supports its effectiveness for migraine ⁴.

External trigeminal nerve stimulation (eTNS)

A device placed on the forehead stimulates branches of the trigeminal nerve.

• It reduced pain during acute migraine attacks in a randomized sham-controlled trial ⁵.
• It has been studied for prevention as well ⁶.

Single-pulse transcranial magnetic stimulation (sTMS)

A handheld device delivers a brief magnetic pulse to the back of the head. It was found to be safe and helpful for prevention in an open-label study ⁷.

Low-level laser therapy

Low-level laser therapy was compared with Botox for chronic migraine, with promising results ⁸. It is part of Dr. Harcourt’s migraine-day protocol for some patients.

Acupuncture

Although not a device, acupuncture also acts on the nervous system, with evidence for prevention ^9,10.

Ear insufflation

Ear insufflation is a gentle, drug-free technique Dr. Harcourt may use in the clinic during a migraine attack. Using a handheld instrument like the one used to look in your ears, the clinician sends soft, rhythmic puffs of air into the ear canal for about 30 seconds at a time. The pressure is mild: just enough to move the eardrum slightly, without causing discomfort. Rounds are repeated as long as symptoms keep improving.

Why the ear? The skin of the ear canal is supplied by a branch of the trigeminal nerve, the same nerve system that carries migraine pain. Gently stimulating it is thought to help calm that pain signal through the brainstem.

In a published case series of 13 people treated in the middle of a migraine attack, 9 had rapid complete or near-complete relief, 3 had moderate relief and 1 did not respond ¹¹. This is early research in a small group without a control group, so larger studies are still needed. Ear insufflation should only be done by a trained clinician after examining your ears. Please don’t try it at home.

Is neuromodulation right for me?

These tools are matched to your exam findings and how you have responded in the past. Some devices require a prescription.

Research cited on this page

1. American Headache Society. The American Headache Society Position Statement On Integrating New Migraine Treatments Into Clinical Practice. Headache. 2019;59(1):1-18. PubMed 30536394 · DOI
2. Tassorelli C, Grazzi L, de Tommaso M, et al. Noninvasive vagus nerve stimulation as acute therapy for migraine: The randomized PRESTO study. Neurology. 2018;91(4):e364-e373. PubMed 29907608 · DOI
3. Silberstein SD, Calhoun AH, Lipton RB, et al. Chronic migraine headache prevention with noninvasive vagus nerve stimulation: The EVENT study. Neurology. 2016;87(5):529-38. PubMed 27412146 · DOI
4. Song D, Li P, Wang Y, et al. Noninvasive vagus nerve stimulation for migraine: a systematic review and meta-analysis of randomized controlled trials. Front Neurol. 2023;14:1190062. PubMed 37251233 · DOI
5. Chou DE, Shnayderman Yugrakh M, Winegarner D, et al. Acute migraine therapy with external trigeminal neurostimulation (ACME): A randomized controlled trial. Cephalalgia. 2019;39(1):3-14. PubMed 30449151 · DOI
6. Russo A, Tessitore A, Conte F, et al. Transcutaneous supraorbital neurostimulation in “de novo” patients with migraine without aura: the first Italian experience. J Headache Pain. 2015;16:69. PubMed 26197977 · DOI
7. Starling AJ, Tepper SJ, Marmura MJ, et al. A multicenter, prospective, single arm, open label, observational study of sTMS for migraine prevention (ESPOUSE Study). Cephalalgia. 2018;38(6):1038-1048. PubMed 29504483 · DOI
8. Loeb LM, Amorim RP, Mazzacoratti MDGN, et al. Botulinum toxin A (BT-A) versus low-level laser therapy (LLLT) in chronic migraine treatment: a comparison. Arq Neuropsiquiatr. 2018;76(10):663-667. PubMed 30427505 · DOI
9. Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016;2016(6):CD001218. PubMed 27351677 · DOI
10. Musil F, Pokladnikova J, Pavelek Z, et al. Acupuncture in migraine prophylaxis in Czech patients: an open-label randomized controlled trial. Neuropsychiatr Dis Treat. 2018;14:1221-1228. PubMed 29785113 · DOI
11. Sullivan DB. Ear insufflation as a novel therapy which produces rapid relief of migraine headache: a case series. Funct Neurol Rehabil Ergon. 2013;3(1):93-107.