By Marcello Cherchi, MD PhD
For patients
Transcutaneous electrical nerve stimulation (TENS) sends a tiny amount of electricity to part of the face. Some types of headache can get better with this.
For clinicians
Overview
Transcutaneous electrical nerve stimulation (TENS), usually targeting the trigeminal nerve, has been studied in the treatment of several headache disorders, including migraine. The evidence of efficacy is moderate. This therapy is safe and generally well-tolerated.
Introduction
The technology of transcutaneous electrical neurostimulation (TENS) units has long been in use for a variety of musculoskeletal disorders. Its application to headache disorders (and particularly for migraine) is more recent.
Mechanism
The mechanism(s) by which TENS works is unclear (Sluka and Walsh 2003). When TENS is used for headache disorders, it usually targets the trigeminal nerve, but the mechanism by which TENS may work for migraine remains unclear. Some literature suggests that the occipital nerve may also be an appropriate target for TENS (Antony et al. 2019; Ellens and Levy 2011), and one FDA-approved device, Relivion®, targets both the trigeminal and occipital nerves simultaneously (Daniel et al. 2021; Daniel et al. 2022; Tepper et al. 2022). There is also some evidence that “remote electrical neuromodulation” (meaning a TENS unit at some site other than the head) may be helpful for migraine (Ailani et al. 2021; Babaei and Rapoport 2023; Blumenfeld et al. 2023; Cowan et al. 2023; Esparham et al. 2023; Grosberg et al. 2021; Grosberg et al. 2022; Hershey et al. 2022; Hershey et al. 2021; Monteith et al. 2023; Nierenburg et al. 2021; Nierenburg and Stark-Inbar 2022; Nierenburg et al. 2020; Rapoport and Lin 2019; Synowiec et al. 2024; Tepper et al. 2020), and the FDA has granted approval for the Nerivio® device.
Several studies of TENS for migraine prophylaxis suggest that it is effective (Di Fiore et al. 2017; Magis et al. 2013a; Schoenen et al. 2013; Vikelis et al. 2017), though not all studies reach the same conclusion (Shirahige et al. 2016). It should also be noted that one study was partially supported by the device manufacturer (Vikelis et al. 2017). Some literature suggests that TENS may also have efficacy as a migraine abortive (Hokenek et al. 2021; Schoenen and Coppola 2018).
Adverse effects
Studies report TENS for headache to be safe and well-tolerated (Magis et al. 2013b). The most common adverse events are local dermatologic reactions at the site of electrode application (Patel et al. 2025).
Cautions and contraindications
Patel and colleagues state that, “Medico-legal recommendations from device manufacturers advise against the use of TENS over the eyes, areas of broken skin, or in patients with conditions such as epilepsy, pregnancy, or those with implanted electrical devices, including pacemakers, implantable cardioverter-defibrillators, or spinal cord stimulators. Additionally, the application of TENS directly over malignant sides is contraindicated due to the unknown effects of electrical stimulation on malignant cells and potential metastasis” (Patel et al. 2025).
Relevance in otoneurology
Insofar as TENS may treat migraine, it may also help with migraine associated vertigo (MAV), though this has not been specifically studied.
Other notes
TENS units (targeting the trigeminal nerve) for migraine prophylaxis have received FDA approval and are currently marketed in the United States as the Cefaly® device ([No authors] 2014) and HeadaTerm 2®.
References
[No authors] (2014) A transcutaneous electrical nerve stimulation device (Cefaly) for migraine prevention. Med Lett Drugs Ther 56: 78.
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