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SpringTMS, sTMS mini Alternatives

If you had success with the SpringTMS or sTMS mini, what can you do for treatment in the wake of the eNeura bankruptcy news? A number of you have asked this question and, unfortunately, there’s no great answer. eNeura had no backup plan in place for patients to continue accessing the device and there’s no news about another company purchasing the assets. (Though it’s been just over two months since eNeura filed for bankruptcy, so that may still happen in time.)

Here are some ideas for alternatives to talk to your health care provider about.

TMS stands for transcranial magnetic stimulation. This technology first became known as an in-office treatment for depression and is offered by psychiatrists. If you only used the SpringTMS as an acute treatment, it’s worth checking to see if any psychiatrists near you offer the treatment in their offices. The device and protocol are different, but the basic technology is the same. A psychiatrist might be willing to work with you to find an effective use for migraine. (I admit this is a long shot. It’s the only way I know to access TMS currently.)

Transcranial direct current stimulation (tDCS) is a less well-known therapy that has been studied for migraine. When I first wrote about TMS, a tDCS researcher reached out to tell me that he thought tDCS was a more effective treatment. That’s about all I can tell you—it has been researched and has shown some promise—but I don’t know how similar it is to TMS. It does seem closer to TMS than the other available devices, but my take is not rooted in a careful scientific analysis. However, it is something to talk to your health care provider about in case tDCS is a good alternative for you.

And that’s really your best option—talk with your health care provider about what might be a good treatment given your particular migraine symptoms and frequency and which treatments you have responded to in the past. Other devices (like gammaCore, Cefaly, or Nerivio) are possibilities, though their technologies are different than TMS. Or maybe a CGRP inhibitor would be a good option for you. Only you and your health care provider can find the best solution for you.

I wish I had better suggestions. My heart hurts for everyone who has experienced an increase in the frequency or severity of their migraine attacks from no longer having access to this device. I will share any new information as it becomes available.

Note: I’m having some temporary issues with comments not appearing on the blog. I still see comments you leave and if you check the box that says “Notify me when new comments are added to this post,” you’ll get an email when I reply. I’m working on getting the comment view fixed ASAP.

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Cefaly Now Available Without a Prescription

You can now purchase a Cefaly Dual without a prescription. It’s currently $399 on the Cefaly website and has a 60-day trial period.

I have mixed feelings about Cefaly being available over-the-counter. Cefaly has brought at least some relief to many people I know. I also know others who have had a lasting worsening of their migraine attacks after using it. While that could be coincidental, headache specialists have told me that they’ve seen the same. My headache specialist told me that of all the devices, Cefaly is the only one he’s seen patients have a lasting worsening of symptoms with.

Early on, some providers recommended patients push through the increased pain for weeks to months to see if they would eventually notice an improvement. That’s when my specialist noticed the lasting increase in symptoms with his patients. The continued use through pain could very well be the problem—not the use itself—so a short-term trail may be just fine.

I don’t want to dissuade people from trying Cefaly—but do caution you to be mindful when doing so. Here are some recommendations for trying it:

  • Even though you don’t need a prescription, consult the health care provider who would have prescribed the device before you try it. Ask for their recommendations for safe use. Be sure to ask the questions that will help you feel comfortable using it.
  • Start on the lowest setting and see how you do. If you notice an improvement, try sticking at that level for a while to see if it’s enough before increasing the intensity. If you don’t notice an improvement, ease into an increase slowly.
  • If you notice a worsening of your symptoms when you use the device, don’t try to push through to see if things improve. Consult your health care provider instead. You may want to try it several times to be sure the device is the culprit and the worsening isn’t coincidence (which it very well could be), but that’s best to do under the supervision of a health care provider.

A friend shared the news of Cefaly’s OTC availability and mentioned that her implanted nerve stimulator experience was a nightmare. She said that experience has made her cautious about trying anything that might make her worse. Similarly, my nerve stimulator implant also made me aware that the things we try to improve our health can instead exacerbate our symptoms. I’m sure I am more cautious than most people—I got that way out of experience and fear of worsening my already tenuous health.

So take what I say here with a grain of salt if you need to. I don’t want to scare anyone, but do recommend an abundance of caution when trying Cefaly.

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How are you holding up?

We’re six-ish months into everyday life during a pandemic, racial tension is boiling over, and we’re in the midst of a horrible election cycle. It’s an understatement to say that life is hard right now. I’ve heard from countless people with headache disorders and other chronic illnesses who are experiencing an increase in symptoms. Depression is creeping up for many. Even my healthy loved ones are feeling frayed.

I found myself thinking of you all as I listened to Brené Brown’s latest podcast episode, On My Mind: RBG, Surge Capacity, and Play as an Energy Source. She talked about the frustration and despair that’s rampant right now. She referenced an article I read last month and found really helpful for understanding my current stressors, Your ‘Surge Capacity’ Is Depleted — It’s Why You Feel Awful. In addition to explaining the “why,” which I always love, the article has good coping tips.

So how are you doing? How do you feel physically? Emotionally? What coping skills are you using to get through this difficult time? I understand if you don’t want to share in the comments (though you can post anonymously), but you’re welcome to send me an email if you’d like to catch me up.

If you’re curious, I’m doing OK. I’m heartbroken by the number of people who have died because of how the country is handling COVID. I’m disheartened and worried about race relations in the US (while at the same time have some hope for change). I’m anxious about the election and sad about Ruth Bader Ginsburg’s death. And yet, I’m holding up fairly well. Here are the high points:

  • The isolation is surprisingly fine for me. I think that’s because I’ve been housebound before, so I’ve already developed coping skills to manage it. Also, last time I believed it would never end, while this time I think it will.
  • When the weather and migraine attacks allow, I’m getting outside for walks. That’s a huge benefit to my mental health.
  • While my migraine attacks are worse than they’ve been for a few years, I think they’re improving now that monsoon season is over.
  • My husband is my favorite person to spend time with and we’re having fun at home together. We’re able to be in separate spaces during the day, so I don’t even have to listen to him on Zoom at work (which would definitely stress me out).
  • My mom and I are working on an oral history project. We’re having great conversations every week and I’m learning a lot about her and our family.
  • I have regular video chat dates with friends to do puzzles (not puzzles with pieces—more like logic puzzles). I love both the people and the activity.
  • I’m doing more advocacy work and getting excited about writing again. It feels great!

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Take 10 Minutes to Help People With Cluster Headache

Oxygen is an effective, safe, and relatively inexpensive treatment for cluster headache. Yet Medicare and Medicaid (and, by extension, many private insurance companies) don’t cover home-use oxygen as a cluster headache treatment.

Public Comment Open Through September 16

The Centers for Medicare and Medicaid Services (CMS) is reviewing their policy and is open to public comment through Wednesday, Sept. 16. If they reverse their decision to allow for oxygen coverage, then private insurance companies will likely follow. That would widely expand the number of people who have access to this treatment.

How to Leave a Comment

The Alliance for Headache Disorders Advocacy created a guide for submitting comments to CMS and include links to PDFs with specialized information for patients and caregivers. The gist:

  • Write a comment about the efficacy of oxygen for cluster headache and your experience with cluster headache, if you have it (but you don’t have to have cluster headache to comment!)
  • Submit your comment on the CMS website.

That’s all there is to it. Obviously, spending more than 10 minutes to write a high-quality comment, especially if you have cluster headache or love someone who does, would be fantastic. But if you can only leave a quick comment, please do.

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I’m Afraid of COVID—and Migraine is the Reason Why

People are falling all over themselves to declare they aren’t afraid of COVID. Some eschew masks and precautions all together to show they are unafraid. Others—those I’m more likely to encounter—do wear masks, but make sure others know it isn’t out of fear. They have reasons at the ready—usually that they’re afraid of getting someone else sick—and attribute their concerns to caution, rather than fear.

I don’t do that and I don’t understand the compulsion to do so. I willing say that I’m afraid of getting COVID. I am not immunocompromised. I am not an essential worker. I’m unlikely to get anyone else sick (other than my husband and that thought does scare me). And I’m being more cautious than almost anyone I know.

Why am I so afraid? Because I live with a chronic illness and know what it’s like to lose physical capacity. I will do anything I possibly can to avoid the risk of adding more symptoms to the list of those I already live with.

No one knows what the lasting effects of COVID will be for people who survive. Some will be just fine. Others report lingering symptoms, including impaired breathing, headache, and fatigue, not to mention organ damage. (Headache specialists are seeing new patients with post-COVID headache—living with another headache disorder or worsening the one I already have? No thank you.)

I have had chronic migraine for three-quarters of my life. I’ve had enough relief in the last few years to feel almost normal. Yes, I still spend an inordinate amount of time managing triggers and on self-care to avoid a migraine flare-up, but, nonetheless, I feel mostly healthy. Before the stress of 2020 triggered a migraine exacerbation, I could exercise daily, work almost full-time, buy concert tickets and know I’d be able to attend, make plans with friends and not have to cancel them, plan a trip and be able to enjoy it. Healthy people take those things for granted. I do not, I cannot knowing what it’s like to live such a limited life.

The thought of having lasting impacts of COVID that could potentially rob me of my normalcy is enough to convince me to quarantine for two years if I have to. I have no problem loudly proclaiming that I’m afraid of getting COVID.