For years, various classes of drugs—including beta-blockers, calcium channel blockers, tricyclic antidepressants, triptans, and antiseizure drugs—have been used to treat migraine. The newest drug class comprises the calcitonin gene-related peptide (CGRP) monoclonal antibodies, three of which were approved for treating migraine in 2018 and episodic cluster headache in 2019. Last year, an additional CGRP drug was approved for the preventive treatment of migraine.

Researchers have known for years that CGRPs are associated with migraine pain; when released around the nerves of the head, they cause blood vessels to expand and trigger inflammation. The new medications block the peptides or the receptors they bind to. Four of the CGRP drugs used to prevent migraine are injected or infused: eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality). Two other recently approved drugs that block CGRPs—ubrogepant (Ubrelvy) and rimegepant (Nurtec)—are known as gepants and are taken orally to treat an acute attack.

Despite these important additions, patients need to remember that no drug is 100 percent effective against migraine, says Mark W. Green, MD, FAAN, emeritus director of the Mount Sinai Center for Headache and Facial Pain in New York City. Patients often need to try different drugs and devices or a combination of the two to get relief.

They now have more neuromodulation devices to choose from, including the Cefaly Dual, which attaches to the forehead with adhesive electrodes and delivers an electric current to the branches of the trigeminal nerve (which controls sensation in the face) to prevent migraine or treat an acute attack. A study in a 2019 issue of the journal Cephalalgia found that using the device for an hour resulted in significant relief for the majority of participants. It costs $349 and doesn’t require a prescription.

Other devices, which require prescriptions, are gammaCore, Nerivio, and Relivion. The cellphone-size gammaCore ($175 for the first three months) is applied to the neck, where it sends electrical stimulation through the skin to reduce pain. A study in a 2018 issue of The Journal of Headache and Pain found that the device works quickly for the acute treatment of migraine and consistently reduces pain intensity and decreases use of rescue medications.

Nerivio ($10 for the first device with pharmacy or medical insurance) is an armband that sends electric pulses, delivered by a smartphone, to stimulate small nerves in the upper arm. Those nerve signals are received by a pain regulation center in the brain that releases neurotransmitters to inhibit pain signals. A study in the December 2020 issue of Pain Medicine found that 59 to 74 percent of Nerivio users achieved pain relief in at least half their treated migraine attacks.

The Relivion headband stimulates the occipital and trigeminal nerves to relieve migraine pain (occipital nerves affect the base of the skull). A study presented to the American Headache Society in 2019 found that 46 percent of participants with episodic or chronic migraine achieved complete pain relief at the two-hour mark after using Relivion for an hour. Approved in early 2021 in Israel, Relivion isn’t yet available to consumers in the United States.

“It’s exciting to have nondrug options,” says Barbara L. Nye, MD, co-director of the Headache Clinic at Dartmouth Hitchcock Medical Center in Hanover, NH. “There are no side effects, and patients can treat themselves at home.” Dr. Green adds, “These wearable devices can be used with drugs for added effectiveness.”

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New Treatments May Reduce Severity and Frequency of Migraine