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Nerivio®

Reviewed by: HU Medical Review Board | Last reviewed: April 2023

Nerivio® is a wearable armband device. It is used to treat pain from acute migraine attacks without drugs. Nerivio is approved by the US Food and Drug Administration (FDA) to treat acute and preventive treatment of episodic and chronic migraine. People with episodic migraine disease have fewer than 15 headache days per month.1-4

Nerivio can be used for migraine attacks with or without aura.4

When a migraine attack or aura begins, Nerivio can be strapped to a user’s upper arm. Electrodes in the armband touch the wearer’s skin. They deliver low-energy electrical pulses to help control pain.2

Nerivio is based on remote electrical neuromodulation (REN) technology. Clinical trials have established that REN is noninferior to tested therapies for acute migraine. This means Nerivio does not perform worse than established medicines.1-3

The wearable device is controlled by a Bluetooth-enabled smartphone or tablet. It can be used preventatively, every other day, or for treating acute migraine pain.2,3

How does Nerivio work?

Nerivio uses electrical stimulation to activate a pain management system that already exists in your brain. This system is called conditioned pain modulation (CPM).1

CPM is based in the brain stem. It is a critical part of the nervous system’s pain perception. The brain stem may decide that a painful stimulus such as a headache is not a threat. When this occurs, it sends out messenger chemicals called neurotransmitters to block the pain.1,3

When someone uses Nerivio, its low-energy electrical pulses activate their CPM. This then prompts the release of pain-blocking neurotransmitters.1,3

Although CPM is in everyone, it does not work as well in some people. This may be because it is not properly activated. REN stimulates or “turns on” CPM. This leverages the body’s own pain management system to relieve migraine pain.3

How to use Nerivio

Nerivio will stay strapped to the arm for 45 minutes per session. Users can control the intensity of their electrical stimulation with an app on their smartphone or tablet. They should adjust the electrical stimulation until it is perceived as slightly less than their headache pain. The app communicates with the therapeutic device over Bluetooth. It turns itself off automatically.2

The smartphone-based app includes a headache diary. Users can track their treatment sessions in the diary and share it with their doctor.2,3

What are the possible side effects?

Side effects can vary depending on the specific REN device used. People using Nerivio may feel local sensations of:2,5

  • Warmth
  • Numbness in the arm
  • Redness
  • Itching
  • Tingling
  • Pain and muscle spasm

Side effects typically resolve on their own within a day.5

These are not all the possible side effects of Nerivio. Talk to your doctor about what to expect when using Nerivio. You also should call your doctor if you have any changes that concern you when using Nerivio.

Other things to know

Nerivio works best if treatment is started when a migraine is beginning. It may not work as well once the pain has increased.2

The American Headache Society recommends REN therapy plus medicine in those with:1

  • An inadequate response to their acute migraine medicine
  • Frequent attacks who may be at risk of developing rebound or "medication overuse" headaches

People who have episodic migraine disease and overuse migraine drugs are at risk of developing chronic migraine. When someone has more than 15 headache days per month, they have chronic migraine.3,4

Nerivio should not be used in people with certain conditions, such as:2

  • Uncontrolled epilepsy
  • Congenital heart failure
  • Severe cardiac disease
  • Severe cerebrovascular disease

Nerivio should also not be used in people with active implantable devices, such as:2

  • Pacemaker
  • Hearing aid implant
  • Implanted electronic device

Before beginning treatment for episodic migraine, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

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