1 Recommendations

Guidance

1.1 Evidence on the safety of transcutaneous electrical stimulation of the supraorbital nerve for treating and preventing migraine is adequate and raises no major safety concerns. For efficacy:

The evidence for treating an acute migraine attack is adequate but, for treating subsequent attacks, is limited in quality and quantity. So, for treating acute migraine, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.
The evidence for preventing migraine is inadequate in quality. So, for preventing migraine, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.

1.2 Clinicians wanting to do transcutaneous electrical stimulation of the supraorbital nerve for acute treatment of migraine should:

Inform the clinical governance leads in their healthcare organisation.
Give people and their families and carers clear written information to support shared decision making, including NICE's information for the public.
Ensure that people and their families and carers understand the procedure's safety and efficacy, and any uncertainties about these.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedures outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.

1.3 Healthcare organisations should:

Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.

1.4 Patient selection should usually be done by clinicians (including clinical nurse specialists) with expertise in managing migraine.

1.5 NICE encourages further research on transcutaneous electrical stimulation of the supraorbital nerve for treating and preventing migraine. Studies should describe clearly whether the procedure is used for treatment or prevention. They should include details of patient selection, and the intensity, duration and frequency of use. Outcome measures should include the number and severity of migraine episodes, quality of life in the short and long term, any changes in medication and management of subsequent attacks. The development of any complications after starting treatment should be documented.