Dr. Roach

Dr. Keith Roach

DEAR DR. ROACH: My child has been prescribed a device by their neurologist to treat their migraines. My child is 18 and has suffered migraines since the age of 4. Due to other prescriptions for a neuromuscular disorder, my child’s doctor does not want to add another prescription into the mix. After insurance initially paid for the device, we are left to pay for the refills that cost $59 for 12 treatments. Given the frequency of my child’s migraines, this could be a large ongoing expense.
This leads me to two questions: Does this device actually work, or is there a placebo effect? Why isn’t this treatment covered by insurance like other pharmaceuticals? — C.M.
ANSWER: Nerivio is a device that uses electricity to reduce pain. TENS units do that as well, but Nerivio is another type of device that uses a different mechanism called conditioned pain modulation to reduce pain. Very roughly, the device stimulates nerves in the upper arm (the device is placed on either arm) to inhibit pain centers deep within the brain. It can be used every other day to prevent migraines or to treat a migraine that is occurring. It is controlled by a mobile phone app. The device is used for 45 minutes.
Two trials have shown that the device is effective — 76% effective (versus 24% with a placebo device) in one study and 67% effective (versus 39% with a placebo device) in another. In adolescents, it seemed to be even more effective. So, to answer your first question, it actually does work better than a placebo, although some people get benefit from just the placebo. In any given person, it is impossible to know whether the benefit would be seen with a placebo device without trying it, which isn’t always easy to do the way it is done for a placebo-controlled trial. The major harm was mild warmth, redness or numbness on the arm or hand.
There are other electrical devices for migraines, but Nerivio seems to have a slightly better effectiveness than the others, although they have not been compared head-to-head.
Nerivio has potential benefits for your child — and many others — in that it is not a medication and cannot interfere with other drugs. I wish I could explain why some treatments are covered by insurance while others are not, but I cannot answer your second question. I will say that a migraine medication like the sumatriptan injection is about $50 per dose without insurance; though, companies like GoodRx can lower the cost to less than $10 a dose. You are still paying about $5 per use of the device.
DR. ROACH WRITES: In April, the U.S. FDA approved selling naloxone nasal spray without a prescription. It is safe and very effective when used properly. Since opiate overdose is a major cause of death in the U.S., it’s important to learn how to recognize opiate overdose, especially for family members of people who use opiates, whether recreationally or prescribed. It is also important to have naloxone available. I carry naloxone with me, and I recommend trained providers do as well.
Detailed information for professionals, including prescribers and first responders, as well as patients and family members, is available at tinyurl.com/naloxoneOD.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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