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Want to zap that headache?

By Amanda Schaffer

New York Times News Service

In ancient Rome, patients with unbearable head pain sometimes were treated with jolts from the electricity-producing black torpedo fish, or electric ray.

Scribonius Largus, physician to Emperor Claudius, was a staunch advocate of the remedy. "To immediately remove and permanently cure a headache, however long-lasting and intolerable, a live black torpedo is put on the place which is in pain, until the pain ceases and the part grows numb," he wrote in the first century.

Electric fish long have disappeared from the medical armamentarium. And patients with headaches are most frequently treated with pharmaceuticals.

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But recently, electrical or electromagnetic devices that hark back to the head-zapping torpedo fish have come into vogue among the country’s most prominent migraine researchers. Two different kinds of stimulatory devices are now in large-scale clinical trials for possible use in patients with the most severe migraine cases. Many researchers believe that such devices are likely to play a greater role in migraine treatment in the future.

30 million strong

Roughly 30 million Americans suffer from migraines, an inherited neurological disorder characterized in part by painful, throbbing headaches.

Dr. Richard B. Lipton, a professor of neurology at the Albert Einstein College of Medicine and director of the Montefiore Headache Center, said that while there are many drugs to treat the disorder or ward off the pain of an attack, some people do not respond or cannot tolerate the side effects.

"There is still a lot of unmet need," Lipton said. "So the idea of having stimulatory devices that can be used to prevent headaches or to treat them acutely is very attractive to me, and I think very attractive to patients as well."

The two kinds of stimulatory approaches are occipital nerve stimulation, or ONS, and transcranial magnetic stimulation, or TMS.

In occipital nerve stimulation, a pacemakerlike device is connected to electrodes placed at the back of the head just under the skin. Electrical current is delivered through these electrodes, with the goal of inhibiting or preventing migraine pain.

In transcranial magnetic stimulation, a magnetic device is pressed to the back of the head, and brief pulses are delivered, altering electrical activity inside the brain in hopes of halting the migraine before it progresses. This approach is being studied only for patients whose migraines begin with an aura, or premonitory phase, that is typically characterized by flashing lights or other visual disturbances.

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Experts say approaches like these represent a powerful new trend in migraine research.

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