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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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SpringTMS, sTMS mini no longer available?

The maker of SpringTMS and sTMS mini, eNeura, filed for Chapter 7 bankruptcy on Friday, August 7. In Chapter 7 bankruptcy, companies liquidate their assets, so this doesn’t look good for short-term access to SpringTMS. I don’t know anything for certain, though—all the information I have is the bankruptcy filing and that eNeura’s customer service is not responding “due to unforeseen circumstances,” as the auto replies say. Despite this, their website is still active.

That’s unfortunately all I can say for certain right now. I have industry contacts keeping an eye out for the SpringTMS to become available to patients again, whether from eNeura or another company that purchases the technology.

I’m sorry to share such bad news. My heart hurts for everyone who relies n these devices for migraine management and wish I had more information for you. I’ll keep you posted if I learn anything new.

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Virtual RetreatMigraine This Weekend—Join Me!

Please join me this Friday, Saturday, and Sunday, April 17-19, for the virtual RetreatMigraine experience—a series of information sessions on migraine that will stream on Facebook Live on the Coalition for Headache and Migraine Patient’s Facebook page. Here’s a schedule of the free events so you can watch live. I’ll be on a panel on Friday and will be leading a session on self-care on Saturday that I’m really excited about. I’d love for you to join me!

virtual RetreatMigraine schedule

If you’re not familiar, RetreatMigraine is an annual in-person retreat sponsored by CHAMP. The second annual retreat was scheduled for this weekend in California. When it had to be rescheduled, CHAMP decided to make some of the sessions virtual and open them up to anyone who was able to attend. It’s a great lineup of knowledgeable speakers, so I hope you’re able to watch some of the events.

Relevant links:

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Aimovig Insurance Coverage: Will Insurance Cover Amgen’s New Migraine Prevention Drug?

Do insurance companies offer Aimovig insurance coverage?

Depending on the insurance company, Aimovig insurance coverage could already be available! Some readers have reported success with getting insurance coverage already. 

My insurance company told me Aimovig came out too late to be included on their current formulary, which is updated twice a year. I was told they’ll make a determination for the January 2019 or July 2019 formulary. As a fellow advocate pointed out, if this were a cancer drug, insurance companies would be unlikely to tell patients they have to wait six months to a year to learn if it will be covered. If I decide to continue with Aimovig after the free trial, I will actively pursue coverage, which will certainly involve letters from my doctor and insurance appeals. I’ll let you know how it goes.

If it’s not available yet, will Aimovig insurance coverage eventually be available?

The likelihood that insurance companies will cover Aimovig and other CGRP-inhibitors is promising. ICER, the organization that insurance companies look to for guidance, issued a report on May 31, 2018 that CGRP-inhibitors are a cost-effective treatment for both episodic migraine and chronic migraine. The migraine advocacy community was pleasantly surprised by this news and is hopeful that it bodes well for coverage. ICER has yet to make its final determination and insurance companies are free to make their own decisions no matter what ICER determines, but we’re in better shape than expected at this point.

The bottom line? Check with your insurance provider now to see what their policy is and, if they aren’t covering it yet, when they plan to make a decision. (And know it’s worth going through the appeals process even if they say they don’t cover it yet. If nothing else, if you have commercial insurance, that will make you eligible for Amgen’s Bridge to Commercial coverage program.)

Will Medicare and Medicaid cover Aimovig?

Probably yes, eventually. I know that’s a lot of equivocation! Medicare and Medicaid are usually slower to adopt medication coverage than commercial insurance companies are. The ICER report could work in our favor though, especially if it’s considered more cost-effective than Botox, which Medicare and Medicaid do cover.

Patience and Optimism

Advising people to be patient is tough—we’ve already waited so long for the first CGRP drug to become available. Though I do think coverage will come sooner than we might expect. I can’t overstate how important it is that ICER’s report determined that CGRP-inhibitors are cost-effective for people with chronic migraine and those with episodic migraine. Combined with Amgen’s two-month free trial and Bridge to Commercial Coverage program I wrote about yesterday, people with commercial insurance have a promising outlook.

Unfortunately, I know many of you have state or federal insurance, which doesn’t benefit from these programs. The disparities in access to medical treatments makes me sick. If you have Medicare Part D, you may be available for coverage through the Amgen Safety Net Foundation

How about you? Do you have Aimovig insurance coverage? Please leave a comment and let us know what your experience has been like?