October 27, 2026 | By Jeannine Thomas, PA-C, MPAS | Neuro On Call
Migraine care is not one-size-fits-all. Alongside medication and behavioral approaches, noninvasive neuromodulation devices offer another option for some people. They use electrical stimulation or magnetic pulses to influence nerve pathways involved in migraine. Most are used at home, and several have FDA-cleared acute, preventive, or combined indications.
These devices are not interchangeable, and FDA clearance does not mean a device will work for everyone. The right choice depends on the device’s labeled use, your health history, access, cost, and treatment goals.
What is neuromodulation?
Neuromodulation uses controlled electrical or magnetic stimulation to affect activity in the nervous system. Depending on the device, treatment may be used during an attack, on a regular schedule to help prevent attacks, or both. Some devices stimulate nerves through the skin; one uses magnetic pulses directed through the scalp.
At a glance
DeviceWhere it is usedFDA-cleared migraine usePrescription CEFALYForeheadAcute; episodic prevention in adultsNo NerivioUpper armAcute and prevention, ages 8+Yes gammaCore SapphireSide of neckAcute and prevention; migraine indication includes ages 12+Yes SAVI DualBack of headAcute and preventive use; age and use details depend on labelingYes Relivion MGForehead and back of headAcute treatment in adults 18+Yes HeadaTerm 2ForeheadPrevention of episodic migraine in adults 18+No Enso for MigraineForeheadAcute and preventive treatment in adults 18+No
Age limits, schedules, contraindications, and availability can change. Check the current instructions for use and discuss the specific model with your clinician.
Devices used for migraine
CEFALY: external trigeminal nerve stimulation
CEFALY uses an adhesive electrode on the forehead to stimulate branches of the trigeminal nerve. It has separate programs for acute treatment and prevention. The preventive program is generally used daily; the acute program is used during an attack. CEFALY is available without a prescription in the United States for adults. Tingling, local discomfort, or skin irritation can occur.
Nerivio: remote electrical neuromodulation
Nerivio is worn on the upper arm and controlled with a smartphone app. It uses remote electrical neuromodulation, a method intended to activate the body’s descending pain-regulation pathways. Its FDA-cleared use includes acute and preventive treatment, with or without aura, for people ages 8 and older. Acute sessions are used when symptoms begin; prevention is generally every other day. It requires a prescription.
gammaCore Sapphire: noninvasive vagus nerve stimulation
gammaCore is a handheld device placed against the side of the neck. It delivers brief stimulation to the vagus nerve. The device has FDA-cleared migraine uses for acute treatment and prevention, including for adolescents 12 and older. Treatment schedules differ by purpose and should follow the prescription and device instructions. It requires a prescription.
SAVI Dual: single-pulse transcranial magnetic stimulation
SAVI Dual is held against the back of the head and delivers magnetic pulses through the scalp. Its FDA-cleared migraine use includes acute treatment and prevention. It is a prescription device. Because magnetic stimulation can interact with some implanted devices or metal, review the manufacturer’s safety information and your medical history with your clinician before use.
Relivion MG: combined trigeminal and occipital stimulation
Relivion MG is a prescription headset with electrodes at the forehead and back of the head. It stimulates branches of the trigeminal and occipital nerves and is FDA-cleared for acute migraine treatment in adults 18 and older. It is not labeled for migraine prevention.
HeadaTerm 2: forehead stimulation for prevention
HeadaTerm 2 is a nonprescription forehead device that uses transcutaneous electrical stimulation. Its FDA-cleared indication is prophylactic treatment of episodic migraine in adults 18 and older. It is not cleared for acute migraine treatment. Its evidence base is less established in current migraine neuromodulation guidelines than that for several other devices.
Enso for Migraine: an OTC forehead device
Cleared by the FDA in April 2026, Enso for Migraine is an over-the-counter device for adults 18 and older who have been diagnosed with migraine by a physician. Its indication covers acute treatment, with or without aura, and prevention. Enso was cleared after the evidence search for the 2025 International Headache Society guideline, so that guideline did not evaluate it.
What does the evidence say?
The International Headache Society’s 2025 evidence-based guideline conditionally recommends CEFALY, Nerivio, SAVI Dual, and Relivion for acute migraine treatment. For prevention, it conditionally recommends CEFALY, Nerivio, and gammaCore. The evidence quality ranged from very low to moderate, so these recommendations are not guarantees of benefit.
The guideline’s evidence search ended in April 2025. It found too little evidence to make evidence-based recommendations for some uses, including acute gammaCore, preventive SAVI Dual, and HeadaTerm. “Insufficient evidence” means the available studies did not support a recommendation; it does not prove a device cannot help a particular person. Enso was cleared later and was outside that review.
Safety and practical questions
Possible side effects vary by device and may include tingling, skin irritation, discomfort, dizziness, or muscle twitching. Device-specific warnings and contraindications matter. Some devices may not be appropriate with certain implanted electronic or metal devices, seizure or cardiovascular conditions, or problems at the treatment site. Pregnancy and breastfeeding data are limited for several devices.
Before choosing one, review the current instructions for use with your clinician. Ask about the exact indication, treatment schedule, prescription requirements, replacement electrodes or supplies, total cost, and insurance coverage. Do not stop prescribed migraine treatment without discussing it with your healthcare provider. A device may be used alone or alongside medication as part of an individualized plan.
Choosing a device
No single device is best for everyone. A clinician can help weigh your migraine pattern, prior treatment response, medical history, age, preferences, and budget. At Neuro On Call, we provide virtual neurology care for patients ages 14 and older in Texas, Arizona, California, Nevada, North Carolina, and Alaska. Visit Neuro On Call to learn about services or schedule a consultation. No referral is needed.
References
Medical disclaimer: This article is for education and does not replace individualized medical advice. FDA-cleared uses, safety information, insurance coverage, and device availability may change. Follow the current device instructions and consult a qualified healthcare professional about your care.
