Migraines can cast a long shadow over daily life, impacting everything from work and social activities to simple
moments of joy. The throbbing pain, often accompanied by nausea, sensitivity to light and sound, can be incredibly
debilitating. Many individuals find themselves on a relentless search for effective relief. While medication remains
a cornerstone of treatment for many, the desire for more holistic approaches, coupled with concerns about side
effects and the potential for medication overuse, has led many to explore non-pharmacological treatments. This
case study delves into the application of Transcutaneous Electrical Nerve Stimulation (TENS) as a physiotherapy
tool for migraine management. We'll examine how TENS, specifically using a device like Axonease, can be
integrated into a comprehensive physiotherapy plan, focusing on assessment, protocol selection, and outcome
monitoring, all within the scope of physiotherapy practice. "Transforming physiotherapy, one patient at a time."
Migraines are characterized by severe headaches, often accompanied by a constellation of other symptoms,
including nausea, vomiting, and heightened sensitivity to light (photophobia) and sound (phonophobia). Under-
standing the nuances of migraine in children is also crucial, as early intervention can significantly impact long-term
outcomes. The exact cause of migraines is complex, involving a combination of genetic and environmental factors.
The pathophysiology of migraines involves a cascade of events, including cortical spreading depression and the
activation of the trigeminovascular system.
TENS, or Transcutaneous Electrical Nerve Stimulation, is a non-invasive technique that uses low-voltage elec-
trical currents to stimulate nerves through the skin. The goal is to alleviate pain by stimulating the release of
endorphins (the body's natural painkillers) and by blocking pain signals from reaching the brain. In the context
of migraines, TENS aims to modulate the trigeminal nerve, a major nerve involved in head and facial pain.
The mechanism of action for migraine relief is thought to involve the stimulation of the trigeminal nerve, which
can modulate pain signals. TENS units can be used to treat various types of pain, including headaches and
migraines.
Let's consider Sarah, a 42-year-old woman who had been struggling with chronic migraines for over a decade.
(Name changed for privacy.) Her migraines occurred approximately three to four times per month, with each
episode lasting between 24 and 72 hours. Sarah described her pain as throbbing and intense, typically localized
on one side of her head. She also reported experiencing nausea, photophobia (sensitivity to light), and phono-
phobia (sensitivity to sound) during her migraine attacks. Sarah's medical history was otherwise unremarkable,
and she was not taking any other medications regularly.
Before seeking physiotherapy, Sarah had tried various over-the-counter pain relievers and prescription medica-
tions, with limited success. While some medications provided temporary relief, she was concerned about the
potential side effects and the increasing frequency of her migraines. Her migraines significantly impacted her
ability to work, socialize, and enjoy her daily life. She was referred to physiotherapy for a non-pharmacological
approach to migraine pain management.
Our initial assessment went beyond the basics. We delved into Sarah's medical history, migraine patterns, and
potential triggers, using the latest physiotherapy techniques to understand her unique situation. This included
assessing her posture, neck mobility, and muscle tension in the head and neck region. We also used a pain scale
(0-10) to quantify her pain intensity during and between migraine attacks. A detailed neurological examination was
conducted to rule out any other underlying conditions. Understanding the neurobiology of migraine is essential
for effective treatment planning.
Based on the assessment findings, a TENS protocol was developed using the Axonease device. The protocol
involved the following parameters:
• Electrode Placement: Two electrodes were placed on Sarah's forehead, targeting key nerves linked to
migraine pain. The exact placement was just above the eyebrows, bilaterally, over the supraorbital nerves. This
placement was chosen to target the trigeminal nerve branches, which are often implicated in migraine pain.
Alternative electrode placements were considered, but this placement was chosen based on Sarah's specific
pain patterns and the evidence supporting its effectiveness.
• Frequency: A frequency of 100 Hz was selected, based on evidence suggesting that high-frequency TENS is
more effective for acute pain relief.
• Intensity: The intensity was gradually increased until Sarah reported a comfortable tingling sensation, without
causing any pain or muscle contraction.
• Duration: Each TENS session lasted for 20 minutes, administered twice daily during migraine-free periods,
and as needed during acute migraine attacks.
• Mode: Continuous mode was used for consistent nerve stimulation.
Sarah was instructed on how to use the Axonease device safely and effectively at home. She was also educated
about migraine triggers and strategies for managing her condition, including stress reduction techniques and
lifestyle modifications. Sarah was taught to monitor her symptoms and adjust the TENS parameters as needed,
within the guidelines provided.
After four weeks of consistent TENS therapy, Sarah reported significant improvements in her migraine symptoms.
The frequency of her migraines decreased from three to four times per month to one to two times per month. Her
pain intensity scores also decreased, from an average of 7/10 to 4/10 during migraine attacks. She also reported
a reduction in her reliance on pain medication, using it only for the most severe episodes. Specific data points
from Sarah's pain diary showed a 50% reduction in the number of migraine days per month.
Beyond the pain relief, Sarah regained control of her life. She felt more energetic, less anxious, and finally able to
enjoy daily activities again – a testament to the power of accessible, personalized care. Sarah was able to return
to work full-time and resume her social activities. She expressed a significant improvement in her overall quality
of life.
This case study demonstrates the potential of TENS therapy, specifically using a device like Axonease, as
a valuable non-pharmacological tool in physiotherapy for migraine management. By carefully assessing the
patient's condition, developing a tailored TENS protocol, and providing ongoing support, physiotherapists can
help individuals with migraines reduce their pain, decrease their reliance on medication, and improve their overall
quality of life. The key findings of the case study highlight the potential benefits of integrating TENS
therapy into a comprehensive migraine management program.
As physiotherapists, we're dedicated to providing evidence-based, patient-centered care. We know migraines are
tough, and we're here to help you find lasting relief. TENS therapy is just one of the many tools we can use to
help individuals manage their pain and improve their function. We believe that by combining TENS with other
physiotherapy interventions, such as exercise, manual therapy, and education, we can provide comprehensive
and effective care for individuals with migraines. If you are experiencing migraines and are interested in exploring
non-pharmacological treatment options, we encourage you to consult with a qualified physiotherapist. They can
assess your condition, determine if TENS therapy is appropriate for you, and develop a personalized treatment
plan to help you manage your migraines and improve your quality of life. "Personalized care, powered by
innovation."