Beyond medication · Neuromodulation
Neuromodulation: drug-free migraine treatment that actually works.
FDA-cleared devices that use mild electrical or magnetic stimulation to interrupt migraine signaling. Worn on the arm, the forehead, or held against the head. Real medicine — just not in pill form.
What it is
A real treatment category — not a wellness gadget.
Neuromodulation devices use mild, controlled electrical or magnetic stimulation to interrupt the neurological signaling involved in migraine. They’re FDA-cleared, backed by clinical trials, and prescribed by clinicians as legitimate alternatives or complements to medication. They’re not wellness products, not supplements, not unregulated wearables — they’re medical devices with real evidence behind them.
There are several FDA-cleared options currently available for migraine:
- Nerivio — a remote electrical neuromodulation device worn on the upper arm during an attack
- Cefaly — a transcutaneous supraorbital nerve stimulator worn on the forehead, used both acutely and preventively
- gammaCore — a non-invasive vagus nerve stimulator held against the side of the neck
- sTMS (Spring TMS, Savi Dual) — a single-pulse transcranial magnetic stimulation device held against the back of the head
Each works through a different mechanism and serves a different patient profile. None of them replace medication for most patients with frequent migraines, but they meaningfully expand the toolkit — particularly for patients who can’t take medication or want a drug-free option to add to what they’re already doing.
How they work
Different devices, different approaches, same general goal.
The common thread across neuromodulation devices is that they modulate the nervous system signaling that contributes to migraine — without medication. How they do that varies by device.
Nerivio
Uses remote electrical neuromodulation (REN). Worn on the upper arm, it delivers a controlled electrical signal that activates pain-modulation pathways in the brainstem — essentially turning down the volume on the pain signaling system from a distance. Used during an attack.
Cefaly
Uses transcutaneous supraorbital nerve stimulation. Worn on the forehead, it stimulates the supraorbital and supratrochlear nerves — branches of the trigeminal nerve, which is central to migraine generation. Daily preventive use is shown to reduce migraine frequency over time. Acute use during attacks can shorten and weaken them.
gammaCore
Uses non-invasive vagus nerve stimulation. Held against the side of the neck for short sessions, it stimulates the vagus nerve, which has been shown to modulate pain pathways relevant to migraine and cluster headaches. Used both preventively and acutely.
sTMS
Uses single-pulse transcranial magnetic stimulation. Held against the back of the head, it delivers brief magnetic pulses that disrupt the cortical spreading depression — the wave of brain activity associated with migraine aura. Most effective when used at the very onset of an attack, especially during aura.
The clinical evidence varies by device, but all four have shown statistically meaningful reduction in migraine frequency or severity in controlled trials.
Who qualifies
Particularly valuable for specific patient situations.
Neuromodulation devices are FDA-cleared for adults with migraine, and several are now also cleared for adolescents. They’re particularly valuable for:
Good candidates
- Patients who can't take medication. Pregnancy, breastfeeding, certain cardiovascular conditions, severe medication allergies, or other contraindications can put medications off the table. Neuromodulation has no drug interactions, no systemic side effects, and a very clean safety profile.
- Patients who want to reduce medication use. Some patients are using acute medication too often (more than 10 days per month) and need to cut back to avoid medication overuse headache. Neuromodulation gives them a non-medication option for some attacks.
- Patients who want a drug-free option as part of their plan. Adding a device to a medication-based plan often produces better outcomes than medication alone.
- Adolescents and younger patients. Several devices are now FDA-cleared for ages 12 and up, where medication options can be more limited.
- Patients with strong migraine aura. sTMS in particular shows benefit when used during the aura phase, before pain begins.
May not be the right fit
- Patients who prefer the convenience of a single medication
- Patients with implanted electrical devices (pacemakers, deep brain stimulators) — most neuromodulation devices are contraindicated
- Patients with metallic implants in the head (for sTMS specifically)
- Patients who want a treatment that's typically fully covered by insurance — coverage for neuromodulation is improving but still inconsistent
The Wellday assessment includes neuromodulation in the conversation when it makes clinical sense. We don’t push devices, but we don’t dismiss them either.
What to expect
What treatment actually feels like.
The experience varies considerably by device. Here’s what to expect from each.
Nerivio
Worn on the upper arm, controlled by a smartphone app. At the start of a migraine, you slip on the device, set the intensity to a level that feels strong but not painful, and run a 45-minute session. The sensation is a mild tingling or pulsing on the arm. About 50% of patients see meaningful reduction in pain within 2 hours of a session. Best for patients with episodic migraine.
Cefaly
A small electrode device that adheres to the forehead. Daily 20-minute preventive sessions or acute 60-minute sessions during an attack. The sensation is a tingling or pressure on the forehead — initially noticeable, gets less so over time. Preventive use over 1–3 months typically produces meaningful reduction in monthly migraine days for responders. Suitable for episodic migraine.
gammaCore
A handheld device held against the side of the neck for 2-minute sessions. The sensation is a contraction of the neck muscles, briefly. Used 3 times per day preventively, or at the onset of an attack acutely. Most effective for episodic migraine and for cluster headaches. Comes with a prescription card that loads monthly with usage credits.
sTMS
A device held against the back of the head, delivers a brief, single-pulse magnetic stimulation. Acute use: at the onset of an attack, particularly during aura. Preventive use: twice daily. The sensation is a quick tap or click — most patients describe it as unfamiliar but not uncomfortable. FDA-cleared for episodic migraine in adolescents and adults.
General timeline. For preventive use, all devices need 1–3 months of consistent use to assess effectiveness. For acute use, response is per-session — some sessions work well, others less so, similar to the variability of acute medications.
Combining with medication. All four devices can be used alongside acute and preventive medications. Many patients use them as adjuncts rather than alternatives — adding a device to an existing medication plan to handle breakthrough attacks or reduce overall medication frequency.
Side effects
The cleanest side-effect profile in migraine treatment.
Neuromodulation devices have a notably clean safety record. The most commonly reported issues:
Important contraindications
- Implanted electrical devices (pacemakers, deep brain stimulators) — most neuromodulation devices are not safe to use with these
- Metallic implants in the head (for sTMS specifically)
- Pregnancy is generally not a contraindication, but check with your clinician
No drug interactions
Because there’s no medication, there are no medication interactions. This is part of what makes neuromodulation valuable for patients on complex medication regimens for other conditions.
No systemic side effects
No fatigue, no weight changes, no cognitive effects, no GI issues. The side-effect profile is entirely local to the device.
How Wellday handles it
We discuss it. We prescribe it when it fits. We’re honest about coverage.
Neuromodulation devices are part of Wellday’s broader toolkit, not a standalone offering. Here’s how we approach them:
We discuss them when they make clinical sense.
During your video consultation, your clinician evaluates whether a neuromodulation device fits your situation — based on your migraine pattern, what you've tried, your medication tolerance, and your preferences. We don't push devices; we offer them as part of the conversation when relevant.
We prescribe them when chosen.
Each FDA-cleared device requires a prescription. Wellday's clinician handles the prescription as part of standard care.
We coordinate device acquisition.
Some devices ship directly to patients from the manufacturer; some require pharmacy fulfillment. Wellday handles the coordination on either path.
We're honest about insurance coverage.
Insurance coverage for neuromodulation is improving but inconsistent. Some plans cover Cefaly with prior authorization. Some cover Nerivio. Coverage for gammaCore and sTMS is more variable. Out-of-pocket costs vary significantly: from around $50/month for Nerivio with insurance, to $300+ per device for sTMS without coverage. We tell you upfront what to expect.
We file PA appeals when appropriate.
Some neuromodulation prescriptions require prior authorization, and some denials are overturnable. We handle that process when it makes sense.
We integrate the device into your overall care plan.
A neuromodulation device isn't a standalone solution for most patients — it's one tool in a broader plan. Wellday's clinician integrates the device into your full treatment strategy and adjusts the rest of your plan accordingly.
Wellday Care covers the clinical care, prescription, and coordination. The device cost is separate and varies by device, insurance coverage, and treatment frequency. Your clinician will give you a clear picture of total expected cost before prescribing.
Common questions
Questions we hear all the time.
Are neuromodulation devices as effective as medication?
For most patients with frequent migraines, medication produces stronger results than devices alone. But for many patients, devices add meaningful benefit on top of medication — and for patients who can't take medication, devices can be the primary preventive approach. The honest answer is that they're real medicine, with real but more modest effects than the most effective medications.
Can I just buy one of these online without going through Wellday?
Most FDA-cleared neuromodulation devices require a prescription. Some can be purchased directly from the manufacturer with a clinical consultation, but proper prescription, fitting, and care plan integration matters — particularly because device effectiveness depends on consistent, correct use. Wellday's clinical guidance significantly improves outcomes.
Will my insurance cover a neuromodulation device?
It depends on the device, your plan, and your clinical situation. Coverage is improving but still inconsistent. Cefaly and Nerivio are most often covered, sometimes with prior authorization. gammaCore and sTMS are less commonly covered. Your Wellday clinician will give you a realistic expectation based on your specific insurance.
Can I use a neuromodulation device during pregnancy?
Most neuromodulation devices are considered safe during pregnancy, but practice varies. Cefaly is the most studied and is often used for pregnant patients who can't take medications. Your clinician will discuss specific options for your situation.
How long until I know if it's working?
For preventive use, most devices require 1–3 months of consistent use to assess effectiveness. For acute use, you'll know within a few sessions whether the device produces meaningful relief for your attacks.
Can I combine a device with my CGRP medication?
Yes. Combination of a CGRP medication and a neuromodulation device is common for patients with chronic or treatment-resistant migraine. The two work through different mechanisms and can be additive.
Related treatments
Keep exploring your options.
From the founder
“I suffered through migraines for two decades before I got real treatment. Wellday is what I wish I’d had — and we’re building it to be seamless and accessible to everyone like me.”
— Jeff Glasco, Founder
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The information on these pages is for general education about migraine and its treatments. It is not medical advice and is not a substitute for evaluation, diagnosis, or treatment by a licensed clinician. Wellday’s care plans are developed individually for each patient based on clinical history, current medications, and personal situation. Always consult with a clinician before starting, stopping, or changing any medication. If you are experiencing a medical emergency or sudden severe headache with new neurological symptoms, call 911 or go to the nearest emergency room.