The following is my headache results with electric muscle stimulation (EMS) and builds on a prior blog where I did the same thing but with somewhat different electrode placement, and slightly different parameters programmed into my EMS machines. Treatment results on 20 headaches had an average near immediate pain reduction of 90% effectiveness (which is phenomenal) is presented in the table, with headache characteristics, pain intensity (out of 10) immediately before the treatment, immediately after and 5 minutes after treatment as well as how many milliamps the each patient worked up to. This is not what I think anyone should do, it’s not advice, it’s just what I did with my patients and what happened. Details and further discussion are below.
|Treatment #||Headache Description||Pain Before||Pain Immediately after||Pain 5 min later||Points Change||% Change||max mA SONS||max mA ONS||Comments|
|1||occipital headache, worse on right||4||0||0||4||100.00%||14||37|
|2||3 frontal after MVA||3||1||1||2||66.67%||19||39|
|3||bilateral frontal headache symmetrical||5||0.5||0||5||100.00%||14||31||no pain over weekend|
|4||occipital headache & up to temples, frontal region, all day long||7||3||0||7||100.00%||14||33||no pain over weekend|
|5||forehead, just came on, usually lasts all day, comes on for her when not stressed||3||0||0||3||100.00%||17||33||no pain over weekend|
|6||temples, on right and right eye||5||0||0||5||100.00%||15||33|
|7||posterior neck, and frontal||5||1||0||5||100.00%||17||49|
|8||central top of head pain, 3-4 hour duration||5.5||0||0||5.5||100.00%||18||40|
|9||occiptal||5||1||0||5||100.00%||17||40||didn’t return for over a week|
|10||top center of head, since she woke up||7||4||3||4||57.14%||15||35||repeated EMS but no additional change|
|11||temporal bilateral||2.5||0||0||2.5||100.00%||18||40||says it felt like it “opened her up”|
|12||left eye and occiptal region, neck||6||4||2.5||3.5||58.33%||18||44||repeated EMS decreased HA to 1.5|
|13||occiptal||2||1||1||1||50.00%||20||42||gone an hour later and did not return|
|14||mostly top of head, says it felt like her brain||6.75||0||0||6.75||100.00%||20||35|
|15||left side occipital pain||4||0||0||0||100.00%||14||43||gone 4 days before returning|
|16||cervical, subocciptal, temporal 2 day duration||3.5||0.5||0||3.5||100.00%||9||18|
|17||left temple, 5 hour duration, post MVA||1||0||0||1||100.00%||13||40||says she could feel her muscles relaxing as she went, even in forehead, neck felt real good after, pain hadn’t returned by next day|
|18||supraorbital and temporal 30-40 min duration||7||0||0||7||100.00%||14||25||normally gets HA weekly|
|19||2 days constant due to eye strain, orbital/occipital||6||1.5||1||5||83.33%||17||34||0/10 20 min later, returned to 5/10 2 hours later and 6.5/10 3 hours later|
|20||frontal & occipital, on and off for a month||10.0||2.0||2||8||80.00%||4||16|
Average pain reduction for these parameters has been 90% with combined occipital nerve stimulation (ONS) with channel 1 like before where I got 78% pain reduction. However with the second series I added a 2nd channel of supraorbital nerve stimulation (SONS) over the supraorbital nerves (on the forehead right above the eyes) thus attempting to mimic what was done in the percutaneous (surgically implanted) electrode studies where they noticed considerably better response than with occipital/suboccipital stimulation alone, and where it was determined safe in the Cefaly safety study. Here are the results, with comments and precautions below:
Compared with my prior study, not only did I add the extra channel, but also changed my duty cycle with parameters as follows:
- Pulse duration: 300 uS
- Pulse amplitude: varied, generally considerably less for ONS (occipital nerve stimulation) than supraorbital nerve stimulation (SONS), see graph
- Pulse frequency: 120 Hz
- Ramp up: 1 second
- Ramp down: 0 seconds
- On time: 5 seconds
- Off time: 15 seconds
- Treatment time: 12 minutes
Note that my pulse width and treatment frequency are higher than was established as safe in the Cefaly (basically a TENS headband) study so anyone looking to recreate my results is taking their health into their own hands. Again, I’m not advising anyone to copy me, I’m just sharing what I do and how well it has worked thus far. Know that every electrical stimulation device comes with a warning not to put the electrodes on your head.
If you want to play it safe, and perhaps smart, the Cefaly parameters used in the treatment of 2313 headache sufferers were as follows:
- Pulse duration: 250 uS
- Pulse amplitude: 16 mA
- Pulse frequency: 60 Hz
- On time: ?
- Off time: ?
- Treatment time: 20 minutes
The safe/smart approach might not work as well though. My larger pulse with delivers more current to the neck and head, but it’s been my observation that patients compensate for this by using less pulse amplitude (mA) thus keeping electrical charge (the best measure of dose) roughly equal. In my ongoing experiments I have switched from using the EV-906 machine to a Globus Genesy 300 with a pulse width of 450 uS and mA tolerated is considerably less. I think my results may be better than the Cefaly results because of my use of the larger rubber carbon electrodes making more stimulation more comfortable, the use of two channels of stimulation instead of one, perhaps my higher pulse frequency or ‘rate’ maybe resulting in high-frequency fatigue of the painful nerves as I blogged about here. Also my programming 5 seconds on 15 seconds off, might be of benefit because when I later tried continuous stimulation, with otherwise identical parameters and it didn’t seem to work as well, though I only tried it on 7 headaches before I got a better idea to test.
Also note that I put channel 1 electrodes on the back of the neck/occipital region, and channel 2 electrodes on the supraorbital. I do not mix and match them. Splitting the electrodes from one channel to the head and neck would result in ‘transcerebral brain stimulation’ with a machine that is a lot stronger than is known to be safe to do so, so I definitely would caution anyone against that, and I have not tried that on myself or anyone.
I switched to the Globus Genesy in part because it’s a true biphasic symmetric current, vs by biphasic asymmetric for the EV-906. In practical terms means both channels of the electrode feel of equal strength in the Globus, while on the EV-906 the ‘red’ wire feels maybe 30% weaker. For personal use on headaches I think this distinction is of minimal consequence, as even with the 30% weaker red wire of the EV-906 can be considerably stronger than anyone with a headache is going to want to use, and near immediate headache reduction of 90% speaks for itself. My switching to the Globus machines is because they became my go-to stimulator in my office where I’m mostly treating other body parts, because increased ease of use, durability, battery life, and power for stimulating other body parts. So for headaches I think the EV-906 is more than enough and about ⅓ the price of the Globus. A smaller ‘programmable’ two channel capable of hitting mine or Cefaly like parameters should be plenty, but I haven’t experimented with any two channel units to have a favorite as of yet.
- The parameters in this study are still what I would call EMS (electric/electrical muscle stimulation) rather than TENS (transcutaneous electrical nerve stimulation) with EMS generally stronger and intermittent. EMS is type of TENS typically used to strengthen muscles but there is research that says it helps with pain better than TENS, and when I first applied it to the suboccipital region I had pretty good results acutely decreasing pain, at least seemingly better than that produced in the Cefaly research. Note however that I don’t use a control/placebo group, and at this point when I apply EMS/TENS to a patient for a headache I tell them I expect this is going to work. So there is certainly a positive expectation. Still the results presented above are remarkable so I do think there is a real effect going on.
- A few observations is that it seems really good at knocking out periodic or frequent headaches, if not immediately, within 5 minutes afterwards of the cessation of stimulation.
- The headaches appear to be gone for a long time, generally not returning for days to weeks.
- It seems to help, but unfortunately does not always eliminate pain in people suffer chronic headaches, generally defined as 15 or more per month. I’ve only had two patients with chronic headaches and both said the the machines helped enough that they purchased an EV-906 for home use. However I’m still disappointed that they weren’t fully cured, hence I’m continuing read, research, and experiment with EMS/TENS parameters.
- The other group that didn’t as well (just 4 patients, so I hesitate to draw conclusions) were those with headaches secondary or related to post-concussion syndrome.
So that’s what I have thus far. I’m currently trying out a new series of tests using a program of frequency modulated TENS, which thus far (4 headaches) is 100%, but I’ll share that data and my program parameters if it turns out preferable.
As always, if you have any further questions or need for clarifications, please don’t hesitate to ask. Being aware that some of my blog ideas are contentious and occasionally a bit out of the field of my expertise, I encourage my readers to come forth with any questions/comments that are of interest or concern. Your comments are valued and welcomed.
Chad Reilly, Physical Therapist