Evidence indicates that combining behavioral treatments with pharmacological treatments for migraine prevention improves efficacy, however little is known about the outcomes of combining neuromodulation and behavioral interventions for acute treatment of migraine. Remote Electrical Neuromodulation (REN) is an FDA-cleared non-pharmacological migraine treatment. The current study evaluated the clinical benefits of augmenting REN treatment with a specially tailored behavioral therapy comprised of Guided Intervention of Education and Relaxation (GIER), for the acute treatment of migraine.
In this two-arm observational study, real-world data were collected from patients across the United States who were using the REN device. Eighty-five migraine patients aged ≥18, who treated their attacks with REN in parallel with the GIER intervention were individually matched on age and sex with 85 patients who used REN alone. The groups were compared on the proportion of migraine attacks in which they achieved pain relief, pain freedom, improvement of function, and return to normal function, at 2 hours post-treatment.
Data from 170 users were analyzed (85 per group). Compared to the REN-only group, the REN+GIER group displayed statistically significant higher proportion of patients achieving consistent pain relief (p = 0.008), consistent improvement in function (p = 0.014), and consistent return to normal function (p = 0.005); all at 2 hours post treatment.
The results suggest that combining the GIER behavioral intervention with REN treatment can improve the therapeutic efficacy beyond that of REN alone, in terms of both pain level and improvement of disability.

© The Author(s) 2022. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.