Transcutaneous Stimulation Device Shows Rapid Acute Migraine Relief In ED

Nihat M. Hokenek, MD, department of emergency medicine, University of Health Sciences

Nihat M. Hokenek, MD

New study results suggest that transcutaneous electrical nerve stimulation (TENS) is both effective and fast-acting, making its use in the emergency department for the treatment of acute migraine attacks.

All told, using the Visual Analog Scale (VAS) to assess perceived changes in pain intensity, those treated with the TENS device (n = 39) experienced a change of —65 ±25 from start to 120 minutes compared to –9 ±2 for the sham group (n = 39; P <.001). Meanwhile, the verbal scores in the 120th minute were 1.2 for the sham group and 4.5 in the treatment group (P&#8239;<.001).

Nihat M. Hokenek, MD, department of emergency medicine, University of Health Sciences, Dr. Lütfi K&#305;rdar Kartal Training and Research Hospital, and colleagues detailed that the work “demonstrated that these devices, utilized in the emergency department, can significantly decrease patients' VAS scores and that these devices are effective within the first 20 minutes of treatment.”

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All told, 30 patients (76.92%) in the sham group and 1 (2%) in the treatment group had additional analgesic requirements after 120&#8239;minutes (difference, 74.3% [95% CI, 59.9—87.6).

Analyzed in accordance with the time -group interaction model, the changes in VAS scores over time were significantly different between groups (F = 91.742; P <.001). At baseline, the treatment group and sham group both had VAS scores of 73 ±3. From baseline to 20 minutes, scores for the treatment group dropped to 22 ±2 compared to 72 ±2 for the sham group. At 120 minutes, those scores dropped to 7 ±2 and 63 ±2, respectively.

The differences between each time point (baseline to 20 minutes, baseline to 120 minutes, and 20 to 120 minutes) were significant for the treatment group (P <.001 for all). The baseline to 20-minute interval change was —51.13 ±2.94 mm, while the 20 to 120 interval change was found to be 14 ±2 mm. In the sham group, the baseline to 20-minute change was not statistically significant (P >.05), though the 20 to 120-minute and baseline to 120 intervals were found to be statistically significant (P <.001 for both)

“This suggests that the TENS therapy was more effective in the first 20 minutes post-treatment,” Hokenek and colleagues wrote. “Our results suggest that, while pain relief starts from the initiation of electrical therapy, this analgesic effect continues after the treatment is concluded, albeit at a slower rate.”

Notably, they also detailed that a number of acute medications—acetaminophen, aspirin, diclofenac, ibuprofen, and sumatriptan among them&mdash;are used regularly in emergency settings. These medications, Hokenek et al. wrote, have been shown to decrease pain by 34% to 57.8% by 2 hours posttreatment. Treatment with the Headaterm TENS device provided 69.66% pain relief.

“This result suggests that TENS devices, like NSAID drugs, may be used in acute migraine episodes and may relieve pain more rapidly than many commonly used medications,” they wrote.

REFERENCE

Hokenek NM, Erdogan MO, Hokenek UD, et al. Treatment of migraine attacks by transcutaneous electrical nerve stimulation in emergency department: A randomized controlled trial. Am J Emerg Med. Published online January 15, 2020. doi: 10.1016/j.ajem.2020.01.024.