By

Regular TENS Unit Instead of Cefaly?

Cefaly“Can I use a regular TENS unit instead of Cefaly?” I’ve been asked this questions so many times that I know others are curious and haven’t asked. I can’t give you a direct yes or no, but here’s what I’ve seen headache specialists say about it.

Writing for the American Headache Society, headache specialist Brian Plato, D.O, says, “It should be noted that “regular” TENS units should not be used in place of the Cefaly.” He does not explain why.

Headache specialist Alexander Mauskop, M.D., said in a comment on my Migraine.com post about Cefaly, “My patients haven’t had much success with Cefaly. To save them money, I suggest that they try a regular TENS unit, which can costs as little as $50. It is not as cool-looking or convenient, but it offers more options in adjusting the current, frequency of stimulation and duration.”

Dr. Mauskop wrote on his blog that he was unsure whether Cefaly has an advantage over a regular TENS unit. He speculates that Cefaly could be better because of its convenience and that the current “may have specific frequency, strength and wave shape, which provides better relief. However, an electrical engineer could easily hook up the Cefaly unit to a monitor and figure out and publicize these settings.” (To my knowledge, no one has done this.)

Many patients point out in forums that their doctors and the instructions with their TENS units say not to use them on your head. One said that a regular TENS unit may be too strong for the forehead.

That’s all I can tell you. I cannot give a direct recommendation either way. Even if I could, I don’t have enough information to form a solid opinion. My best advice is to talk to your doctor about it.

By

Cefaly for Migraine: Diminishing Returns & No Long-Term Relief

My early success with the Cefaly, the external nerve stimulator I told you about last summer, didn’t hold up. I used it for at least an hour a day for six months, over which time my relief from it decreased from three hours a day to no relief at all. None of the published studies on the Cefaly talk about this happening, but none of them studied its use for more than a few months.

The Cefaly can be used to stop migraine attacks in progress (and to stop other types of headaches, according to the manual, though all the published research is on migraine) or as a daily preventive. Since I have (had!) migraines every day, I hoped for both. Not only did I experience diminishing returns of acute relief, I never noticed a preventive effect. Stopping it did not increase my migraine frequency, severity or duration.

I’ve heard from about a dozen of you who tried the Cefaly. No one reported relief even as significant as I had early on and half couldn’t use the device because the sensation in their foreheads was unbearably painful. The Daily Headache readers tend to have chronic and/or severe chronic disorders, so we’re unlikely to be a representative sample. Maybe it’s less effective for people with more severe headache disorders or our propensity toward more significant allodynia (sensitivity to touch) makes it more painful than normal. (If you’re worried it will be painful for you, see if someone you know has a TENS unit you can try. The Cefaly is different than a standard unit in its electrode shape and preset programs, but you’ll get an idea of what it feels like.)

Do I rescind my recommendation? Somewhat surprisingly, no. As long as it’s in your budget (it is returnable, but you’ll be out shipping to and from Canada and a 20% restocking fee), I say go for it. We all respond to different treatments and several headache specialists have told me that even a 10% response rate in early research is encouraging. If you want to explore nerve stimulation without invasive surgery, want a drug-free treatment or haven’t had much luck with standard treatments, the Cefaly is, at the very least, worth a try.

I still have mine and will try it again soon. I’m hopeful that a few months without it will be a sort of reset.

By

Cefaly: What it Feels Like & My Early Experiences With It

You know what Cefaly is, now here’s an overview of using the device, what it feels like, and my early experience with it.

Cefaly has three programs: abortive (programme 1), preventive (programme 2), and relaxation (programme 3). Each program slowly increases in intensity for the first 12 minutes, the levels off  and remains at that strength for the remainder of the 20-minute session. You can push the button at any point to stop the intensity from increasing any further. However, according to the manual, “The effectiveness of the treatment depends on the power used. It is consequently advisable to work with the maximum power possible.”

With this in mind, and because I had a migraine coming on, I started with the abortive program (programme 1). Both the lead researcher and the manual say the sensation isn’t painful, so I was surprised by just how intense it is. I agree that pain isn’t the best description (especially for someone used to migraine pain), but the sensation is far from comfortable. Initially, it feels like a mild buzzing vibration with a sharpness to it that’s not quite pins-and-needles. As the program intensifies, so does the vibration and a feeling of pressure develops, like someone is pushing hard against my head with the heel of their hand. Then a sort of clenching sensation begins, almost as if the muscles were tightening. Again, none of these sensations are exactly painful (unless I already have allodynia), but I am always greatly relieved when the program is over. Anyone with significant allodynia will probably find this device unbearable to use.

The first time I used the Cefaly, I had to stop before reaching maximum intensity. It was just too uncomfortable to continue. When the 20 minutes were up, the migraine felt unchanged. I started it up again (one touch of the button in the wind-down period returns the stimulation back to the maximum strength for the session and it remains there for the next 20 minutes), as the manual says,

“The standard 20-minute session is generally too short, except for mild headaches. Usually it is necessary to carry out programme 1 several times, and for at least 40 minutes. Generally, 2 to 6 sessions of 20 minutes each are needed, depending on each individual. This is not always the maximum either, since Cefaly can be used all day long if needed.”

An hour at not quite full strength eased the migraine from a level 5 to a 3. Not only was I able to go to dinner with friends, I was chatty and felt good. The migraine came back three hours later, which has since proven to be a pattern. Multiple times since then, using the device at almost full strength continuously for an hour has reduced the pain by two levels and I’ve been able to function for a while, though the pain is always back after two or three hours.

What’s most interesting about this is that not only is the pain decreased, but so is my primary prodrome symptom of tooth sensitivity. For the last nine months or so, sensitive teeth on the upper left side of my mouth are a reliable indicator that I have a migraine coming on. Even before I notice increased pain or other symptoms, I feel the sensitivity in my teeth, often testing them with a drink of water. Before I use the Cefaly, my teeth are sensitive; afterward they are not. This makes me think that the migraine process is actually being interrupted, though I don’t know if the science backs me up.

Since the manual says the device is most effective if used at full strength, I kept trying to get there. If the migraine is bad enough and thus my allodynia high, the sensation is unbearable. When I have gotten it up to full strength, the muscles in my eyelids twitch, I feel spasms in the muscles around my eyes, and I cannot keep my eyes open. As I am a master at not listening to my body, I ignored these sensations by distracting myself with a podcast while the Cefaly was on. I was rewarded with a broken blood vessel in my eye.

Thanks to a phobia for all things eye-related, this was a message I could not ignore. I backed off after that, setting the Cefaly even lower than I did for the first few sessions. And it stopped being as effective. It simmered a migraine down one level on the pain scale, reduced my tooth sensitivity without eliminating it, and gave me an hour of productive time before the pain came back.

My final assessment won’t come for at least a few months, by which time I should know if it is preventing any migraine attacks. In the 10 days I’ve used it, I believe it has already given me multiple hours in which I could run errands, write, make it to appointments, or do chores when I otherwise would have been relegated to the couch. That’s worth $230 and $10 per electrode for this chronic migraineur.

By

Cefaly External Neurostimulation Device for Preventing & Aborting Migraine Attacks

Cefaly, an electrical nerve stimulation device that is worn like a headband across the forehead and stimulates the nerves through the skin, is my latest experiment in preventing and aborting migraines. There’s a ton of information to share, so I’m breaking it up into several posts, starting with the basics. If you can’t wait to read about the study, here’s Medscape’s writeup: Neurostimulation Effective in Migraine Prevention. (You can get a login from Bugmenot.)

First off, what the heck is Cefaly? It is basically a TENS unit with an electrode shaped to cover the peripheral branches of the trigeminal nerves in the forehead. Instead of being able to adjust the settings freely as you do on a TENS unit, Cefaly is pre-programmed with three therapeutic settings, one for aborting migraine attacks, one for preventing them, and one for relaxation.

According to Cefaly’s website,

Cefaly treats migraine pain with neurostimulation. A stimulus that limits pain signals from the nerve centre by working on the trigeminal nerve where migraine headaches start. The patented Cefaly treatment changes the trigger threshold of migraine headaches. As the pain threshold becomes harder to reach, migraine headaches are less frequent, less painful, and simply disappear. Cefaly offers patients suffering from migraine pain and headaches an efficient electrotherapeutical system delivered via an extremely comfortable, ergonomic and simple-to-use medical device.

An easy-to-follow marketing video:

Harder to follow without knowledge of scientific terms, this video provides a high-level explanation of the science behind the device:

While the marketing materials focus on migraine (and that’s what my experience represents), the manual recommends its use for tension-type headache, cluster headache, and trigeminal neuralgia. It also claims to reduce stress, promote relaxation, and ease the symptoms of sinusitis, though it does not treat the underlying sinus infection.

Cefaly has not been approved for sale in the US and is is not available here. It is available in Canada, Australia, and Europe. I ordered mine from Costco Canada for $230 USD and had it shipped to a friend in Canada who sent it on to me, though I’m not sure this is strictly legal. My headache specialist said his US patients have ordered it directly from Roxon.ca for $299 USD and Oximetry.ca for $340 USD. Although not inexpensive, $230 is reasonable considering the cost of various preventive and abortive meds.

Replacement electrodes come out to $10 each when shipping is factored in. The life of electrodes is listed at 10 uses in the manual, though reviewers on Costco.ca list various strategies for extending their usefulness. I wash my hands and forehead well before applying the electrode and store it in a Ziploc bag with a cotton ball soaked in alcohol next to it. At 11 uses, my original electrode still seems to be working fine. Even if it costs $1 in electrodes each time I use it, that’s still a savings over what I pay for triptans.

There’s enough hype about Cefaly on the internet that I wouldn’t have even tried it had by headache specialist not recommended it. It just seems too good to be true. At the time I saw my headache specialist in May, he had suggested it to 20 of his patients with intractable chronic migraine and half reported at least some relief from it. One had just written him a letter saying the results were close to miraculous for her. Because I trust my headache specialist immensely, I went for it.

Writing this post, I discovered that headache specialist Alexander Mauskop questions whether Cefaly provides advantages over readily available $50 TENS units. While I could have done with saving some money, I derive comfort from the pre-set programs and am not sure if I could have found the right therapeutic settings on my own. If you already have a TENS unit, it might be worth trying it out on your forehead!

I’m still sorting out the kinks and it is too early to establish any preventive effect, but the device has definitely aborted migraine attacks for me. In Monday’s post, I’ll detail my first week with it.