Your Guide to Getting a Spring TMS

getting-a-spring-tmsA non-drug treatment with few reported side effects that works as both an acute treatment for migraine attacks and a migraine preventive. That describes the Spring TMS, which received FDA approval in 2014 and is slowly becoming available throughout the country. Compared to other technologies, Spring TMS’s rollout has lacked much fanfare, but it’s a pretty exciting treatment with a long history of research to support its use.

Transcranial magnetic stimulation (that’s what TMS stands for) uses a very short magnetic field to send a brief energy pulse through the skull into brain tissue. The pulse causes very mild electrical currents in the brain that are believed to stop a migraine attack by interrupting the abnormal electrical activity in the brain caused by migraine.

My experience with Spring TMS might make you wary. I believe the worsening of my migraine attacks while using it was coincidental, not caused by the device itself. I still advocate for trying it because the research on Spring TMS is quite strong. I also advocate for talking to your doctor about what to do if your head pain worsens while using the device.

Here’s what you need to know for getting a Spring TMS, from which doctors can prescribe it and learning how to use it to its cost and how the rental program works. It contains an exact transcript of the questions an eNeura executive answered for me in April.

Kerrie: Can any doctor prescribe Spring TMS? If not, how can a patient choose a doctor to prescribe it?

eNeura: The device is currently available by prescription in specialist headache centers around the US. If you want to see which doctors near you can prescribe the Spring TMS email or call 1(408) 245-6400, and press 1 to speak with a Customer Care representative. Doctors who are interested in prescribing the device can also email or call eNeura customer care.

How much does it cost?

Spring TMS is available by prescription under a rental program. The cost is comparable to other prescribed migraine treatments. The company offers a $300 discount off the first 3 months for new patients. A new 3 month prescription is $450 ($150 per month) plus a one time $50 shipping charge. Total charges for the first three-month period come to $500.

[The above pricing only applies for the first three months of use. Here’s updated pricing information from eNeura’s customer service department, current as of Aug. 24, 2016: We rent the device in 3-month increments.  At list price, the cost per month is $250. A patient who selects the 12-month option will average $175 per month for SpringTMS. We also offer new patients a $300 discount on their first prescription, which would bring the cost per month down from $250 to $150 for that first prescription.]

Does insurance cover SpringTMS? 

As a new migraine treatment, insurance coverage for Spring TMS varies and will likely require documentation of medical necessity from the prescribing physician. eNeura has retained an insurance reimbursement consulting service for patients wishing to pursue insurance coverage. eNeura Customer care will help you get started. Call 1(408) 245-6400, and press 1 to speak with a Customer Care representative.

Do you bill insurance? If not, have patients been successful applying for reimbursement from insurance companies?

eNeura does not bill insurance companies, but patient’s can submit invoices to their insurance company for potential reimbursement.

How does the rental program work?/How does a patient renew a prescription?

eNeura: Near the end of the three-month period, the patient’s doctor can send a renewal prescription to eNeura. eNeura, in turn, emails an invoice for the renewal period. Once that’s paid they will mail a new SIM card to replace the original SIM card in the machine. If the prescription is not renewed and the new data card is not inserted in the Spring TMS unit, it stops working. 

Is special training required to learn how to use the device?

It is easy to use and is fully automated to guide the patient through treatment in a step-by-step fashion. While there is no special training required, eNeura offers an individualized program to support you as you begin using the Spring TMS.

A Clinical Education Consultant will contact you when your Spring TMS arrives to help you get started and answer your questions. During your first 3-4 months of use, your nurse will continue to support you in your treatment plan, answer your questions, review your diary and report your progress to your doctor. 

Is the unit shipped directly to the patient or does it go through the doctor?

Prescribing doctors send the three-month prescription to eNeura. Once the prescription is received, eNeura prepares the device and ships it directly to the patient’s home.

If a patient stops using the device, how do they return it?

When a patient receives their SpringTMS in the mail they are instructed to keep the original packaging. If a patient stops using the device, it needs to be shipped back to eNeura. Contact eNeura Customer Care to obtain a prepaid return shipping label. There is no charge for returning the device.

What else would you like patients to know about SpringTMS?

Many migraine patients are looking for non-drug treatment options. For them medications either don’t work… may be contraindicated or just not well tolerated. SpringTMS offers a safe clinically proven treatment option without medication side effects.

Longtime reader Timothy Bauer checked in with eNeura on July 20 after reading my article on He was told that doctors who have not already been trained in prescribing the device may have to wait several months for training. The company gave him the names of doctors in his area who have already been trained.



Migraine and Stroke, Heart Disease: Understanding the Risks

Learning that research has found connections between migraine and stroke and heart disease can be chilling. Fortunately, the news is not as bad as it might first appear. I spoke with headache specialist Gretchen Tietjen, M.D., about an article on the connection between migraine and an increased risk of stroke and cardiovascular disease that she wrote for the American Migraine Foundation. “From a patient’s perspective, this information is frightening,” I told her (because I have no poker face, even on the telephone). Dr. Tietjen soothed my worries tremendously by putting the information into perspective.

“It can be very scary when you read things like this,” Dr. Tietjen said. “Study after study shows this little bit of increase.” However, the risk is very small. The most important takeaway is that patients should keep migraine in mind as part of their overall risk for stroke and heart disease. If you have migraine and are at increased risk of stroke or heart disease, it’s extra important to be aware of and manage those risk factors.

Migraine Increases the Risk of Stroke and Cardiovascular Diesease (But Only a Little Bit)

Yes, migraine does increase the risk of stroke, particularly for women who have migraine with aura. But the risk is very, very small. Less than 1% of all strokes in women have any connection to migraine. And the presence of a connection is not proof of a causal relationship—that is, just because the two are linked doesn’t mean that migraine causes stroke.

The article reports that a recent study found “that migraine increases the risk of stroke, coronary events, and related death by about 50%.” At first glance, that sounds terrifying, but Dr. Tietjen’s clarification was soothing. She said, “This sounds worrisome but to put this in perspective only 1% of the total population in the study had a cardiovascular event over the 20 years of follow-up. The take home message is that having migraine does not mean you will have heart disease or a stroke, only that it appears to slightly increase the risk.”

Risk Factors For Stroke and Heart Disease

Dr. Tietjen highlighted risk factors like smoking, high blood pressure, high cholesterol, and diabetes. She said that in people with migraine, these factors have an additive effect—the combination of more than one risk factor is worse than any one by itself. If you have any of these risk factors in addition to migraine, quitting smoking, lowering your blood pressure and/or cholesterol, or getting your diabetes under control could lower your risk of heart disease substantially. Smoking is the risk factor that stands out the most to Dr. Tietjen. Studies of migraine and smoking have shown that the combination of the two increases your stroke and heart disease risk more than either one on it’s own.

Learn More About Migraine, Stroke and Heart Disease

Dr. Tietjen’s article, Migraine, Stroke and Heart Disease has in-depth information on who is at increased risk of stroke, differentiating between symptoms of migraine and stroke, the physiological links between migraine and stroke, and ways to lower your risk. As you read the article, keep in mind that the absolute risk is small and that you can modify your risk factors for stroke and heart disease. And make a list of any questions you may have so you can ask your doctor at your next appointment.


Chronic Migraine Attitude Determines Altitude for Sarah

Sarah, a 20-year-old student at Brigham Young University—Idaho, shared this essay she wrote about living with chronic migraine for her English class.

Pain in My Brain

By Sarah Smith

chronic-migraine-attitudeI bury my head into my pillow trying to apply pressure to my skull. I pull up the covers to block out any light and hopefully to muffle any sound. I lay there motionless. My head throbs, pulsating, feeling as if at any moment it may explode. Dizziness sets in, and I continue to not move; maybe it’ll go away. I start to feel nauseous. I lay there with nothing but this pain and my thoughts: “How long will this last? Why can’t things just be normal?”

I have suffered from chronic migraine since I was five years old. Growing up, doctors would tell me that, “Your migraines will probably go away when you have menopause.” This was not very reassuring to hear. When I reached the age of 14, I started going to a neurologist. I would meet with him every three months and answer all of his questions and give him a review of my health. He prescribed me some medication that only helped some of the time. Eventually, when I was about 15, my neurologist suggested that I get an MRI, which I did, but there was nothing to be found. I continued to take medications for my migraines until I was about 17 when I decided that I didn’t want to be dependent on pills, and that I should try to figure out the triggers that cause my migraines.

Because I get migraines so often, about 3-4 days a week, it was/is hard to pinpoint exactly what the triggers are. It didn’t take long to discover my biggest migraine culprit – florescent lighting. Since the lighting of a room is not something I get to decide, it is extremely difficult to prevent a migraine from happening in these situations. If I’m in a room with florescent lights for a short period time, it’s not that much of a problem. However, high school was incredibly difficult for me, because I was around these lights for eight hours at a time. Much of the time my migraines will last more than a day. Because of this, I would go to school for a day, get a migraine, and miss the following day. This happened so frequently that I missed a large portion of my senior year and almost didn’t graduate.

Some of my other triggers include wind, long exposure to the sun, bright lights, loud noises, inconsistent sleep schedule, and eating more sugar than normal. The symptoms I have from migraines vary on the degree of pain. I usually experience blurry vision, dizziness, nausea, and severe headache.

I have found that the best cure for a migraine is simply to sleep. I will often also take ibuprofen or Excedrin Tension Migraine. Sometimes, even these don’t work, and I just have to wait the migraine out. These are the worst types of migraines, because no matter what I do I just need to let the migraine run its course.

In addition to almost not graduating high school, my migraines have impaired other aspects of my life. When I have a migraine I can’t go out and do the things that everyone else is doing. This was especially hard while growing up, because all I wanted to do was play with the other kids and do what they were doing. It was also hard to explain why I couldn’t go out and play with them. Most children don’t understand what a headache is, let alone a migraine. So in addition to being left out, I was also misunderstood. All I wanted to do was fit in.

In the end, I learned that the state of my health was not the determinant of the relationships I had with my friends. My attitude and character were the deciding factors of my relationships with others. Although I may not have had a physical presence some of the time, I was still able to have a bond with my friends. It also helped that they were genuinely acceptive of me, which made me incredibly grateful.

There is a saying, “Attitude determines altitude.” I have come to believe this. It has helped me to cope with a debilitating chronic illness, and it has brought me closer to my friends, family and God. Thomas S. Monson shared his thoughts on attitude which has been a great inspiration for me. He said, “So much in life depends on our attitude. The way we choose to see things and respond to others makes all the difference. To do the best we can and then to choose to be happy about our circumstances, whatever they may be, can bring peace and contentment. We can’t direct the wind, but we can adjust the sails. For maximum happiness, peace and contentment, may we choose a positive attitude.”

Reader-submitted stories solely represent the personal point of view, experience, and opinion of the author, not of The Daily Headache or Kerrie Smyres.


If Only I Could Keep Running From Grief

Pleasant emotions = good

Painful emotions = bad

These two equations summarize American society’s approach to emotions. We’re taught to strive for emotions that feel good as if seeking higher ground in a tsunami and to run like hell from ones that hurt.

I wrote two weeks ago about slamming the door on my unwelcome houseguest named Grief, trying with all my might to keep it locked away. Grief did not comply with my wishes, not until it ripped the door of its hinges and I gave it the attention it demanded. This behavior is not unique to grief, nor is it a noteworthy show of strength. It’s what all emotions do if you try to ignore them for very long.

The most remarkable lesson I’ve learned about emotions is this: it is (almost always) easier to let myself feel an emotion than it is to try to run away every time one I’m afraid of pops up. Even more remarkable? Unless you feed the fire, stoking the flame with your thoughts, an emotion only lasts 90 seconds. Seriously. A minute-and-a-half.

If this is true, why did I tell you I spent a week avoiding my grief? Why did my therapist (of all people!) say that I was being skillful when I blocked myself from feeling grief? It’s because I was making a deliberate choice. As I said, it’s *almost* always easier to experience an emotion than it is to have it haunt me when I’ve tried to run away. Almost, but not always.

It has been a difficult year. I swear that phrase has been in 95% of the drafts I’ve written since January. It’s actually been a difficult 18 months. When the DAO stopped being sufficient for staving off my eating-triggered migraine attacks, I learned that I no longer only had to grieve for everything I had lost. I also had to grieve for the future I’d finally begun to trust was mine. The ketogenic diet is the last diet-based intervention available to me. When it wasn’t a slam dunk, my grief began to grow. May and June were particularly difficult emotionally.

I’ve been working with my therapist on this grief as it has come up. At the end of June, we decided to dive deep to see if I could face the grief and move on unencumbered (or at least less encumbered). That day was the most horrible, gut-wrenching experience I’ve ever had in therapy.

I used to run from my emotions because I was afraid if I felt them, they would devour me whole. That therapy session felt like I was being eaten from the inside. My stomach churned. My leg muscles seized up. Each time I tried to relax them, they would clench even more. My chest kept tightening and my breath became hard to catch. Although she usually lets me lead the work, my therapist told me it was time to stop. She said I was locked into an extreme flight response. Fortunately, she had a free hour to spend calming me down. I had a grief hangover for a couple days, but that was the only lasting repercussion from the session. Well, that and a fear of what would happen the next time I let grief in.

My therapist and I decided to put the grief work on hold for a while. We check in every week to assess my grief level and how I was dealing with it. I explained how I let myself feel it when it comes up, but only for a short while, then distract myself and move on. This is the behavior she said was skillful. The skill was in recognizing the emotion and choosing to move toward or away from it. I haven’t run from grief reflexively, I have chosen to keep it out of my house. Until it beat the door down.

Writing that post actually kept grief from taking me down. Acknowledging the strength of my grief was enough of a catharsis to last nearly a week. But I knew it wouldn’t hold much longer. Last Tuesday, I told my therapist I was finished running. We revisited the grief work, this time with a gentler approach we tried last month.

I talked about how small my world feels and how migraine prevents me from traveling, working as much as I’d like, seeing my friends, and making new friends. I spend so much time policing my diet in an effort to stay semi-functional, but I’m not really gaining ground. It’s more like I’m standing still and trying desperately to keep the dirt from crumbling away from beneath my feet. I still don’t feel as good as I did in 2014 and I feel like I’m constantly one step away from falling off a cliff.

For me, successful migraine treatment means I can do the things I most enjoy in life. I don’t have to be migraine-free, pain-free, or symptom-free to do this. I spend most of my energy on migraine management, yet it’s still not enough to let me work and play and travel and spend time with loved ones. Migraine continues to dominate every single day. Food, one of my life’s great pleasures, is a chore and a source of pain.

I work so, so hard for so little reward. I am so, so worn down by chronic migraine.

My therapist listened to me and validated me. When the session was almost over, she asked how I was doing. I said that I felt like I needed to curl up and cry for a while. After we said goodbye, I sobbed for an hour. It was an ugly, painful cry that sapped the small amount of remaining strength that I had. I napped and read and took it easy for the rest of the day. I was better the next day, but still tired, sad, and a little lonely.

I know the popular American emotional equations don’t add up. I sometimes wish they did. Running seems so much easier than feeling this pain. I know it is not. I know I can’t outrun it forever. But in times this heavy, I wish I still believed grasping for pleasant emotions would render painful ones obsolete. I wish I still believed in the American way.

I wrote this last Wednesday, but it didn’t post because of a technical problem. As often happens, I felt much better after writing it. I chose to post it today as I wrote it originally because it’s an honest reflection on how wrenching working through deep grief can be. But now you need to read the alternate ending:

I ran from grief because it seemed like the only way I could survive the pain. Even in the immediate aftermath of doing the grief work, I wished I’d kept running. But after a short recovery time, I felt lighter than I had in months. Grief is no longer waiting to ambush me from inside books or thoughts or scenic vistas. I neutralized its power when I stopped running. I don’t believe in the American way of dealing with emotions because my life has shown me time and again that the equations just don’t add up.


Ketogenic Diet Update: Six Months of Ketosis

Six months into a ketogenic diet is a sort of milestone among dietitians. It’s when the body really adjusts to the change—cholesterol settles down and other blood levels that have been out of whack do, too. Here’s where I am after six solid months of ketosis.


My blood sugar has finally stabilized and the hypoglycemia appears to be under control! I think it’s from a combination of time for my body to adjust to the diet and eating so many calories in a day that I can get in enough carbohydrates. I’m eating 13.8 g of carbs each day; at the lowest, I was getting 3 g. It has stabilized enough that I can eat only two meals a day and can exercise without a blood sugar crash.


I am less reactive to foods than I was before I started the diet, but everything I eat is still a migraine trigger. Certain foods are less bad than others and I’m slowly adding in more foods. Now that I’m back to two meals a day, I can take abortives after both meals and remain functional most of the time. (Someone will read this and inevitably be concerned about medication overuse headache/rebound headache. My doctor and I are on top of it.) Sometimes I barely feel the migraine attack at all. The last couple days, I’ve basically been back to where I was before the DHE infusions last summer—I still have a migraine attack every time I eat anything, but they mostly respond to medication (though I have fewer foods than I did then).


The weight loss seems to have stabilized, too. I’m remain at about 18 pounds below my ideal weight even though I try to eat 2,100 calories a day. I don’t know if I just need more calories on a ketogenic diet than I normally do or if I haven’t been hitting my calorie target. My guess is a bit of both. It’s easier to get in all my calories now that I’m on two meals a day, so we’ll see if I gain any weight.

Ketogenic Diet Ratio

When I noticed that I was no longer having hypoglycemic episodes, I increased my ratio from 3.75:1 to 4:1. It was too much—I went considerably deeper into ketosis, my migraine attacks became more frequent, and I lost weight. I also tried to decrease the ratio to 3.25:1 and a significant migraine attack ensued; it was too little. My sweet spot appears to be 3.75:1.

(I’ve learned that a 4:1 ratio is normally verboten for adults who aren’t in imminent danger of death because it’s impossible to meet protein needs within our calorie constraints. Since I have an extra 400 or 500 calories to play with, this doesn’t apply for me right now.)

Vitamin & Nutrient Deficiencies

So far, the diet has caused me to be deficient in iodine, potassium, sodium, chloride, and various B vitamins. I’ve been able to supplement (and use more salt) for everything except the B vitamins. A bad history with multiple different B vitamin supplement has me reluctant to try one. I think today is the day I’ll be brave.

Unexpectedly, my vitamin A is too high. It happens that the least migraine-triggering vegetables for me all happen to be high in vitamin A. Plus, vitamin A is fat-soluble and I always eat it in conjunction with a ton of fat.

Erratic Blood Work

My labs have been all over the place in the last six months. A level will be way high one month and back to normal the next without any change on my part. Almost every level that had been out of whack is back to normal or close to normal as of July 13. I won’t have my cholesterol checked for another couple weeks, but I’m actually hoping it will remain on the high end. One of the preventives on my list to try is a statin, which lowers cholesterol.

My Current Thoughts on the Diet

In summary,

  • I’m not hypoglycemic
  • I no longer have to eat more frequently than my meds can keep up with
  • I’ve stopped losing weight
  • My vitamin deficiencies are minor and so far manageable
  • My labs are pretty good

Obviously the ketogenic diet hasn’t been a slam dunk for me, but it is helping. After spending May and June thinking I would have to abandon it any day, it no longer seems untenable. It’s not ideal and can’t be my final strategy, but it’s getting me through. Now my goal is to maintain the diet long enough to support an aggressive trial of five or six different preventives (not simultaneously). Realistically, that’s probably at least until the end of the year.