Nerivio

Summary:
Nerivio is a wearable remote electrical neuromodulation (REN) device placed on the upper arm. It is FDA-approved for acute migraine treatment and works via conditioned pain modulation.

Biological Plausibility

Nerivio activates descending pain inhibitory pathways through stimulation of peripheral nerves on the arm. This triggers conditioned pain modulation—a mechanism where non-painful stimulation reduces pain perception through brainstem circuits such as the periaqueductal gray and rostral ventromedial medulla.

Evidence

Randomized controlled trials—including a double-blind sham-controlled study—show that Nerivio provides statistically significant improvement in pain freedom and relief at 2 hours post-treatment compared to sham.

Effect Size

In trials, 37% of users reported being pain-free at 2 hours post-treatment, compared to 18% with sham. Additional benefits include reduction of nausea and light sensitivity in many users.

⚠️ Risk

Minimal risk. Most common side effects are mild skin irritation or discomfort at the application site. No serious adverse events reported in trials.

Cost

$$$

Scores

  • Benefit: 4
  • Burden: 5
  • Ratio: 0.8

Clinical Takeaways

  • Effective acute treatment for patients with migraine who prefer non-oral options.
  • Best results occur when applied early during a migraine attack.
  • Requires smartphone pairing and patient engagement to use effectively.

Key References

  • Yarnitsky D, et al. *Remote electrical neuromodulation (REN) for the acute treatment of migraine: a randomized, double-blind, sham-controlled, multicenter trial.* The Lancet Neurology. 2019.
  • Chen WT, et al. *Real-world evidence for effectiveness of REN in treating migraine.* Headache. 2022.
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