My Continued Electric Stimulation Headache Data

 

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   4.9 1.0 0.5 4.2 90% 15 35.35  

 

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

2 thoughts on “My Continued Electric Stimulation Headache Data

  1. I’ve had headaches for as long as I can remember. About one month ago I had a migraine and went straight to bed after work. That night, my puppy insisted on playing and she couldn’t care less that I was in agony, lying in a dark room. She began biting at my hands trying to get me to play. Initially, I wanted to throat punch her… but after she got a few bites in I was Okay with it. I realized the pain in my head was alleviated by the teeth gnawing at my hands. I let the play session go on for at least 30min and afterwards my headache subsided.

    That experience made me wonder if EMS actually treated your patient’s headaches or simply redirected their brains to focus on a different stimulus. Perhaps those two things are one in the same; however, when it comes to headaches, I think it’s more effective to treat the cause rather than the symptom. Unless, of course, the cause of the headaches is head trauma. In that case, alleviating the pain might be as good as it gets.

    I tried using EMS for headaches twice in the past out of desperation. I followed the handy dandy “schematic presentation of normal treatment points” diagram that came with my EMS device. The diagram identified a few locations for headache relief; the temple, the lower leg and the supraorbital nerve region. The same diagram is used by acupuncturists. Considering your harsh criticisms of acupuncture, I can’t help but enjoy the irony of your modern day acupuncture-type technique.

    Out of curiosity, I’ll try EMS on my head (at my own risk) the next time I have a headache. Until then, hopefully I can continue to prevent headaches with good nutrition and exercise.

    • Likely the puppy gnawing on your hand does share some of the same benefits as EMS for headaches. Gate control theory of pain postulates that sensory input from an outside source can inhibit pain. Plus I have a fair number of papers (I’ve yet to read them) that general distraction can decrease pain as well, which I expect is from at least partially overlapping reasons. Also I knew a woman who had chronic migraines but was also into Crossfit who I was coaching on olympic lifts. I was going to teach her snatches, but she didn’t want to do them because she had a bad headache. I said we should just try the snatches and see what happened. What happened was she learned to do full snatches, with the overhead squat, which takes a great deal of effort, balance, and attention. Mid way through I asked her about her headache and she said it was gone.

      So I think EMS anywhere (even an acupuncture point on the foot) if it’s intense enough is likely to have some beneficial effect, particularly if the person believes it will. Per the percutaneous (surgically implanted) electrode studies the pain relief was considerably better if there was what was called “paresthesia concordancy” meaning the electrodes caused tingling over the area of the head where the headache pain was, thus indicating that distraction from the pain isn’t all the story.

      As for treating the cause of migraines rather than the symptom, that would be all well and good, except nobody knows what the causes are. I’m reading a fair number of papers lately which seem to indicate that the whole idea of triggers existing, and thus being avoided is misguided. What seems to be the case is the headaches come on more or less randomly, and people get anxious/superstitious about triggers, which gives them anxiety if they are unable to avoid them, for which if anything the subsequent anxiety triggers a headache in what becomes a vicious cycle. If the headaches are cervical in origin, then I can see better postures reducing frequency, and I think a healthy diet and good fitness can’t hurt.

      So in my headache treatments and test I’m generally putting electrodes over targeted muscles and nerves corresponding to the area of pain. I use large electrodes, for which for which I’m sure there are a fair number of acupuncture underneath, but I don’t consult acupuncture charts, or even recommended stimulation placements points included with any various machines. I did do a blog on research regarding acupuncture points, and electroacupuncture and the non-acupuncture points worked better, so I’m still skeptical (of the acupuncture that is, not the EMS).

      Also while I think the above parameters work great for most types of headaches, I’m trying something a little different now for chronic migraines regarding both electrode placement and parameters. It’s too complicated to try and explain here, but since you are local, I’d say to stop by the office with your EMS machine and I can show you want I’m doing now, and you can give me feedback regarding what you think.

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