Early Administration of Remote Electrical Neuromodulation Enhances Migraine Relief

Initiating remote electrical neuromodulation (REN) within 1 hour of migraine onset is linked to significantly improved pain and symptom relief compared with later initiation, according to real-world findings published in Cephalalgia.

Although pharmacologic agents remain first-line therapy for migraine, neuromodulation has emerged as a noninvasive, drug-free alternative. The US Food and Drug Administration-cleared REN device (Nerivio®) delivers peripheral electrical stimulation to the upper arm to activate conditioned pain modulation pathways and reduce migraine pain.

To assess how treatment timing affects efficacy, researchers analyzed US-based data from REN users collected between January 2019 and December 2024. Patients who initiated REN within 1 hour of migraine onset (early) were compared with those who began treatment after 1 hour (late). Data were derived from the REN companion smartphone application, where users logged baseline characteristics, treatment start time, and outcomes 2 hours posttreatment.

These results underline the importance of educating patients on using REN promptly at migraine onset.

The study included 55,261 patients (mean [SD] age, 37.9 [18.5] years; 83.4% women) who completed 586,981 treatments, 56.5% of which were administered early. Efficacy analyses included between 6413 and 35,581 evaluable treatments, depending on outcome.

Early use of REN produced consistently higher response rates across all efficacy endpoints (P <.001). Pain relief was achieved in 65.1% of early treatments compared with 46.6% of late treatments, and complete pain freedom in 28.8% early vs 14.5% late treatments. Similarly, functional disability relief and freedom were greater among early users (58.1% vs 49.3%, and 35.4% vs 20.9%, respectively). Freedom from migraine-associated symptoms also favored early treatment, including photophobia (26.9% vs 19.0%), phonophobia (34.0% vs 25.9%), and nausea/vomiting (51.5% vs 38.7%).

When analyzed by patient-level consistency, defined as individuals treating early in at least 50% of attacks, similar trends were observed, with pain relief (73.9% vs 53.6%) and pain freedom (30.0% vs 16.6%) significantly higher among early vs late treaters. Subgroup analyses in 8886 youths (mean [SD] age, 15.8 [1.4] years; 84.2% girls) revealed comparable benefits, with early intervention improving pain relief (64.4% vs 41.0%) and functional disability outcomes (62.1% vs 46.2%).

Study limitations include self-reported data and incomplete 2-hour follow-up, which limited available efficacy assessments.

“These results underline the importance of educating patients on using REN promptly at migraine onset,” the study authors concluded.

Disclosures: This research was supported by Theranica. Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.