A migraine is usually a severe headache felt as a throbbing pain at the front or on one side of the head.
A very large number of people, 20% of females and 5% of males suffer from this, without really knowing what to do about it.
Medications have a very limited effect on migraine and that too is fraught with side effects and long-term complications.
The TENS unit has come as a great relief to this painful problem. It can be used to treat and prevent migraine attacks.
What are the symptoms of migraine?
It is a very severe form of headache which generally affects only one side of the head. The intensity could vary from being mild and throbbing to severe unbearable pounding. It not only affects the head but can be felt on the side of the face and neck too. It can last from 4 hours to 72 hours.
Nausea, vomiting, photobia (intolerance to strong light) and phonobia (intolerance to loud noise) is also experienced along with the headache.
The onset of migraine (classical migraine) may be preceded by visual disturbances, blind spots, or tingling sensations on one side of the body and this is known as aura, a forewarning before the actual headache strikes. The occurrence of the aura is not experienced in all the cases (known as common migraine)
In some cases, both sides or the front of the head may also be affected.
The rate of incidence of migraine is much higher than those of diabetes, epilepsy, and asthma put together. It is the second most disabling disorder.
What causes the pain?
It was believed that migraine is the disease of blood vessels in the head. But now it is clear that the vascular system is not involved as the cause. It is the overactive brain nerve cell that triggers a chain reaction and ultimately the trigeminal nerve is affected and results in the devastating pain.
It is the dysfunction of the sensory system. Heredity is one of the major factors of its incidence, but the immediate trigger could be
- Disturbed sleep patterns
- Fasting or stale food
- Hormonal disturbances
It tends to peak around 30-35 years and then with age, it gradually settles down.
How to treat migraine?
Migraine treatment is a challenge. However, at the basic level, one can try some home remedies or lifestyle changes. These may not treat the migraine in the real sense but could reduce the intensity and frequency of the attacks.
- Maintain a very regular and disciplined food and sleep routine. Have your healthy meals on time and sleep at fixed hours. Oversleeping and deprived sleeping both could trigger a migraine. A 7 -8 hours of sleep should be ideal.
- Include some aerobic exercise, in consultation with your doctor as a daily routine. Regular exercises help control migraine.
- Drink lots of water.
- During the Aura, or as you start feeling uneasy, retire to a dark and quiet room and lie down.
- As the symptoms of headache start developing, place a cold and wet towel or an ice pack on your forehead and neck.
Self Migraine medication
At the onset of the migraine, over the counter pain reliever like acetaminophen, ibuprofen or naproxen can be taken. It does provide temporary relief but is not the cure for the ailment.
Overuse of these or prescribed drugs can leave your body in a worse situation leading to acidity or ulcer and bleeding in extreme cases.
The prescribed medicines, though effective is again not a cure and it is treating the ailment symptomatically. And prolonged medication can mess up the body.
In fact, Pharmacological treatment has its limitations in treating migraines.
In some cases, acupressure and acupuncture have shown encouraging results. But because of the lack of therapists and experts of these alternative therapies, it is not very popular and viable.
As shown in the figure below, these acupressure points could be pressed or massaged for relief
TENS unit for pain management
TENS is the acronym for Transcutaneous Electrical Nerve Stimulation. This is a non-invasive, non-pharmacological pain management system. It has almost no side effects, though some precautions need to be taken while using it.
A TENS unit can be used to treat pain like migraine, controlled electrical impulse is transmitted from the unit to the nerves in the affected area, through the skin by means of electro pads that are tapped onto the skin.
It is a battery-operated unit and is completely safe.
The electrical impulse is modulated in terms of
- Pulse amplitude: set in milliamperes
- Pulse duration: set in microseconds
- Pulse frequency: set in pulse/second
The user can set these settings according to his requirements. To begin with, all 3 should be set at very low levels. This may give the patient a mild tingling sensation in the affected areas. Slightly increase the setting until you feel strong impulses in the affected area. Reduce the setting if the muscles twitch very strongly or you feel intense pinprick like sensations.
In some patients, the skin where the electrode pads are stuck gets irritated or burnt. This is because of the very high setting or highly sensitive skin. Treat the skin with some lotions, cream before using the electrode pads on the same spot and reduce the setting.
The TENS UNIT should not be used if
- The patient has a pacemaker or any other electronic implant in his body.
- If the patient is pregnant.
- If the patient suffers from epilepsy or any heart conditions.
The electrical impulse stimulates the peripheral nerves and relief in the pain is experienced. There are two theories to explain this phenomenon
Gate Control Theory
All sensations of the body are conveyed to the brain and instructions from the brain are conveyed to all parts of the body through an intricate network of the nervous system. It is the nerve endings present throughout the body which picks up the “unusual” signal (heat, pain, shock, etc) and transmits it to the brain.
The low amplitude signals, sent by the TENS unit interfere with the ability of the nerves to send migraine pain signals further down the route to the brain. The low amplitude stimulating signals are picked by the nerves and this is sent to the brain and when this is happening the strong and severe pain signal is blocked to travel further. Hence it is called the Gate control theory. A very similar phenomenon occurs when a painful body part is massaged. The dull pain of massage blocks the intense pain from reaching the brain.
According to this theory, the stimulation of the nerves induces the release of endorphin which are natural pain killers and hence the pain is managed. This theory tries to elaborate on the fact that the body has its own defense and recovery system. And this recovery system release endorphin and the pain eventually subsides. This theory off late is losing ground to the GATE CONTROL theory.
The USFDA has approved the over-the-counter sale of the TENS unit. And this therapy is very popular in Europe and the USA.
The TENS UNIT has been successfully used to manage pain in a number of conditions like
- knee pain,
- post-operative pain,
- back pain,
- shoulder pain,
- sports injury
- labor pain
and many more…
Can TENS unit be used for treatment?
Yes, the TENS unit can be used to manage pain in Migraine too. It is found to be effective both in chronic migraine and acute migraine. An alternative such as a cefaly device can also be considered.
Traditionally TENS was not used for headaches and migraine, but in 2014, FDA approved the use of “Cefaly” for patients over 18 years.
It was the first Transcutaneous electrical nerve stimulation device to be approved by the FDA, for the treatment of Migraine.
Cefaly device is classified as an e-TNS (External Trigeminal nerve stimulator) device.
In the previous discussion, we had seen that the Trigeminal nerve plays a prominent role in MIGRAINE. And in accordance with the theory of TENS, stimulation of nerve relieves pain.
It is a very portable device that comes with its own sticky electrode. The electrode pad is stuck on the forehead and the unit magnetically docks on it. On activation, it sends tiny low voltage, low amplitude electrical stimulation to the Trigeminal nerve.
Gradually, there is marked relief in the pain. This can be used to prevent the pain as well. If used during the aura period, it can terminate the pain at that stage itself, vouch lots of users.
The device usually comes with two settings,
- Preventive: To prevent the migraine attack from happening.
- Acute: To treat the migraine, if it has manifested.
FDA approval was given on the basis of the ACME test. (Acute treatment of migraine with external trigeminal nerve stimulation). In this test, 32% of patients were completely relieved of migraine pain in one hour and 65 % of patients experienced a substantial reduction in pain.
Advantages of using a TENS unit to treat migraine
TENS therapy is extremely safe and simple to use and is effective too. You do not have to worry about any side effects. It is economical too, as there is no recurring expense.
Since the unit is very handy, the size of a cell phone, you can carry it along with you and emergency situations can be easily dealt with.
The therapy is self-administered and does not need any specialist or expert assistance. It is very easy to operate the unit.
The only care to be taken is to charge the unit and keep the electrode pads clean and dry.
TENS induced analgesia has no side effects and the body does not develop immunity to it, unlike the drugs and medicines, which become ineffective on prolonged usage.
Though the earliest TENS device for migraine was Cefaly, over a period of time many other manufacturers have come out with their own models adapted for migraine.
How to use a TENS Unit for migraine
The efficiency and effectiveness of the TENS depends on
- When you use the unit?
- At what settings are you using it?
- How have you placed the pads?
The most appropriate time to use the TENS unit is as soon as you feel the symptoms of migraine building up. Do not wait for the pain to reach its peak.
Early therapy may stem the problem at the nascent stage and you may not have to endure the excruciating pain at all.
The unit can be safely used up to 60 minutes at one go and can be used 4-5 times in a day if needed. Do not hesitate to use it whenever required. It is not at all habit-forming. In the absence of any pain, you can keep it aside for weeks, with no withdrawal or side effects.
The following steps can be used as a reference
- The electrode pads should be very firmly stuck on to the skin at the desired locations. It is self-adhesive in nature, but securing it with micropore tape is advisable. The skin surface should be cleanly wiped off to remove any sweat, oil or dirt. It should be dry.
- The electrode pads can be placed in a suitable area.
- Once the electrode pads are secured onto the body, then it should be connected to the unit by means of the connecting wires, provided with the unit.
- Now the unit should be switched on, at the lowest settings and once you get used to the feeling the setting can be increased to the manufacturer’s specifications or to your comfort level.
- Initially use it for a short period of time. This helps your body to adapt to the therapy and then you can use it for 30-45 minutes at a time.
- Once done with the therapy, switch off the unit first and then detach the wires and remove the electrode pads.
- Wipe the pads dry and keep them in the given bag/pouch.
- Keep the unit in the given box and store it in a dry place.
Although Migraine is very painful and traumatic and difficult to manage, now we have a TENS unit, to help you relieve the pain and lead a normal life.
Remember, TENS therapy is approved, convenient, no side effect, non-invasive, non-pharmacological, easy to use, portable, economical and effective.