Efficacy and Safety of Remote Electrical Neuromodulation for Migraine Treatment: A Systematic Review and Meta- Analysis

OBJECTIVE: To systematically evaluate the efficacy and safety of remote electrical neuromodulation (REN) for the prevention and acute treatment of migraine. BACKGROUND: Migraine is a disabling condition marked by recurring headaches. Non-invasive neuromodulation, including remote electrical neuromodulation (REN), offers a potential treatment for both the prevention and acute relief of migraines. REN works by stimulating peripheral nerves in the upper arm to trigger conditioned pain modulation and has been shown to be effective and safe for at-home use in managing migraine attacks. DESIGN/METHODS: A comprehensive search was conducted in PubMed, Web of Science, Scopus, and the Cochrane Library for studies assessing the efficacy of remote electrical neuromodulation (REN) in migraine patients. The studies included various designs such as single-arm, observational, randomized controlled trials, and crossover studies. Key outcomes analyzed were sustained pain relief and pain-free status at 24 hours, reduction in migraine medication days, functional improvement at 2 hours, and the occurrence of adverse events (AEs). Statistical analysis was performed using Review Manager and Open Meta Analyst software. RESULTS: This study evaluated the efficacy of remote electrical neuromodulation (REN) by analyzing 13 studies with 9,912 migraine patients. In single-arm studies, REN showed significant pain reduction and pain-free status at 2 hours, but there was no significant difference compared to placebo. REN provided sustained pain relief and functional improvement at 24 hours, along with a reduction in migraine medication days. While adverse events and device-related events occurred at low but notable rates. CONCLUSIONS: REN showed significant improvement in patients with migraine and significant occurrence of AEs. However, future studies with an RCT design and a long follow-up period are necessary to evaluate its full potential efficacy in migraine. Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff. Disclosure: Mr. Mustafa has nothing to disclose. Dr. Zakria has nothing to disclose. Dr. Abdelsalam has nothing to disclose. Dr. Sharabati has nothing to disclose. Dr. Hassan has nothing to disclose. Dr. Abouelmagd has nothing to disclose.