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Wearable Pain Relief Device May Treat Menstrual Migraines

A white woman wearing the Nerivio device on her arm. She's laying on a white couch looking at her smartphone.

Nerivio

Key Takeaways

  • Research shows that for 50% of people who experience migraines and menstruate, the hormonal changes surrounding menstruation can be a migraine trigger.
  • Menstrual-related migraines can be hard to treat because the symptoms may not respond to the medications that are used to treat other types of migraines.
  • A new technology called remote electrical neuromodulation (REN) has been shown to be effective at treating other types of migraines. Now, researchers say the device may also provide non-drug relief of symptoms for menstrual-related migraines.

Finding a treatment that works can be hard for people who experience migraines that are triggered by the hormonal changes surrounding their menstrual cycles. 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 the typical treatments, such as medication.

To address the treatment gap, researchers have been evaluating a wearable device called Nerivio, which uses a drug-free pain relief method called remote electrical neuromodulation (REN).

What Are Menstrual Migraines?

Migraine symptoms related to the menstrual cycle are common, affecting over 50% of people who menstruate. Hida del Carmen Nierenburg, MD, a neurologist and headache specialist with Nuvance Health, tells Verywell that a person who experiences menstrual migraines gets migraines during menstruation as well as at other times of the month.

Menstrual migraines are thought to be triggered by the sudden decrease in estrogen levels that occurs right before menstruation begins.

Pure menstrual migraine (that only happens during menstruation) is rare, affecting only about 12% of people who menstruate. These migraines occur anywhere from two days before to three days into a person's menstrual period.

“Menstrual migraines tend to be tougher to treat, and the pain is more severe, for unclear reasons,” says Nierenburg. “The way we treat menstrual migraines is sometimes with birth control (oral contraceptives), but the studies are outdated. There’s very little adequate or recent research evidence supporting effectiveness, and for some women, oral contraceptives can make migraines worse.”

Menstrual migraines may not respond to the medications that are typically used for migraine headaches—and it's not clear why.

Some people with menstrual migraines manage their symptoms through "mini-prophylaxis" with non-steroidal anti-inflammatory medications (NSAIDs) and triptans (the standard acute treatment for migraine), which they take for several days during the expected attack.

However, some people cannot use this method because of medication side effects and allergies to NSAIDs. Non-medication alternatives are needed for these people as well as for people for whom these treatments have not been successful.

What Is Nerivio?

Nerivio is the only device with remote electrical neuromodulation (REN) that has been cleared by the U.S. Food and Drug Administration (FDA) for the acute treatment of migraine. 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 as needed. They can control the device via Bluetooth and the device's accompanying smartphone app.

The device applies an electrical stimulus to the upper arm. It is not painful for the wearer, but the signal “tricks” the nerves in the arm into perceiving the sensation of pain.

This, in turn, causes the pain centers in the brainstem to become activated. When this happens, the brain stem releases neurotransmitters—such as norepinephrine and serotonin—to help relieve the pain.

What Does the Research Say?

The researchers gathered information from a retrospective survey that included 91 women between the ages of 18 to 55 who experienced migraines around the time of their menstrual cycle.

Of these women, 68 women (75%) reported at least a moderate relief of their migraine symptoms while they were wearing the REN unit.

The researchers also found that two-thirds of other migraine patients also experienced pain relief after two hours of using Nerivio.

Research has shown that REN can be a safe and effective treatment for teens with migraines and might actually work better than standard treatments. Nerivio has been cleared by the FDA for use in adolescents.

Minimal Side Effects and Risks

Another advantage to REN is that it has minimal side effects. In the trial, 12 of the 91 people who used Nerivio reported mild side effects such as bruising on their arm where they had been wearing the device, nausea, and dizziness.

The device also does not have the potential to interact with other medications that a user might be taking because it is a drug-free pain relief method.

“Migraine patients are sensitive to overuse of rescue medications," says Nierenburg. "Taking triptans or over-the-counter medications such as combination analgesics with acetaminophen and caffeine more than 10 days a month can cause them to have more headaches."

Who Else Could Nerivio Help?

People who used REN therapy to treat their menstrual migraines also reported a decrease in other menstrual-related pain, including cramps (38% decrease) and pelvic pain (37% decrease).

These findings have 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.

Using the protocol created for the research, Nierenburg has also successfully treated patients with chronic migraines that are tough to manage.

Nerivio might potentially be used for other types of pain in the future, but Nierenburg says that other indications for the treatment have not been studied yet.

It's clear that there are benefits to using a drug-free pain relief method like Nerivio that go beyond efficacy; Nierenburg points out that for patients who need pain relief without the sedation that can come with some treatments (such as people who drive for a living or operate heavy machinery), a device like Nerivio could be a good option.

Pregnant patients with pain relief needs can also present management challenges for doctors, as they are limited by what medications they can prescribe. Again, Nierenburg says that an option like Nerivio could meet those patients' needs.

What This Means For You

Nerivio is available by prescription through a specialty pharmacy and it's covered by some insurance plans. If you're having a hard time managing your symptoms, ask your migraine specialist if a REN device like Nerivio could help you.

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  1. Nierenburg H, Rabany L, in T, et al. Remote Electrical Neuromodulation (REN) for the Acute Treatment of Menstrual Migraine: a Retrospective Survey Study of Effectiveness and TolerabilityPain and Therapy. Published online June 17, 2021:1-9.doi:10.1007/s40122-021-00276-7

  2. Cleveland Clinic. Menstrual Migraines (Hormone Headaches). Updated March, 2021.

  3. Nervivo by Theranica. How Does Nervivo Work?.

  4. Theranica. What Is CPM?.

  5. Hershey AD, Irwin S, Rabany L, et al. Comparison of Remote Electrical Neuromodulation and Standard-Care Medications for Acute Treatment of Migraine in Adolescents: A Post Hoc Analysis. Pain Medicine. Published online June 29, 2021. doi:10.1093/pm/pnab197