Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Remote Electrical Neuromodulation for Acute Migraine

Remote electrical neuromodulation (REN) is an effective acute treatment for migraine with noninferior efficacy compared to current acute migraine therapies, a new study suggests. Researchers performed a post-hoc analysis on a subgroup of participants with migraine from a randomized, double-blind, parallel-group, sham-controlled, multicenter study on acute care. The efficacy of REN was compared to the efficacy of usual care or pharmacological treatments. Among the findings:

  • Of 252 patients randomized, 99 were available for analysis.
  • At 2-hour post-treatment, pain relief was achieved in 66.7% of REN participants vs 52.5% participants with usual care.
  • Pain relief at 2 hours in at ≥1 of the 2 attacks was achieved by 84.4% of participants vs 68.9% in usual care.
  • REN and usual care were similarly effective for pain-free status at 2 hours.


Rapoport AM, et al. Remote electrical neuromodulation (REN) in the acute treatment of migraine: A comparison with usual care and acute migraine medications. J Headache Pain. [Published online ahead of print July 22, 2019]. J Headache Pain. doi: 10.1186/s10194-019-1033-9.


Remote Electrical Neuromodulation (REN) is an FDA-cleared non-invasive device which a patient places on the upper arm and activates with a smart-phone application, stimulating for 45 minutes. In the Yanitsky RCT (see above) versus sham, outcomes were similar to conventional triptan treatments: 2h pain relief for REN 66.7% versus 38.8% for sham, P< .0001, and 2h pain-freedom 37.4% for REN and 18.4% for sham, P = .003. Sometimes, post-hoc analysis can be very telling, and the investigators elected to compare usual treatment (UC), including both non-drug treatments and medications in 1-2 attacks in the run-in period to ≥1 attacks for REN in the RCT portion of the study. REN was as effective or more effective than patients’ customary treatment, an exciting finding. There is high likelihood that patients will wish to use REN when it becomes available in late 2019 or early 2020 for acute migraine treatment if cost and access issues can be properly addressed. —Stewart J. Tepper, MD, FAHS, Professor of Neurology, Geisel School of Medicine at Dartmouth, Director, Dartmouth Headache Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH