Botox to nose vibrations: The new treatments offering hope to migraine patients

More than a billion people worldwide struggle to find relief from the unbearable pain of migraine. But research is leading to new therapies against this debilitating condition.

Every morning, between brushing her teeth and her skincare routine, Megan Daniels looks into the mirror and massages the side of her neck with a small device that looks like a walkie-talkie. She moves it around just below her jaw, keeping it there until it tingles and the corner of her lip starts to pull downwards. 

"It's quite soothing, it feels like it's sending waves through your brain," says Daniels, a 35-year-old solicitor from Liverpool in the UK. Each day, she repeats the massage during her lunch break and again in the evening while taking off her makeup before bed. She is using it to help stave off migraine – a debilitating neurological condition that affects more than a billion people worldwide. In the majority of patients, the condition manifests itself with frequent, sharp headaches and a constellation of symptoms like dizziness or visions of light.

Daniels uses a neuromodulation device that uses electric pulses to stimulate the nerves running up into her face and head. "It can put you in a bit of a trance when you do it," says Daniels.

Despite being so widespread, the exact causes of migraine and the reasons for its diverse set of symptoms are still largely a scientific mystery. But as researchers begin to unravel this puzzling condition, they are also discovering new ways to treat it. From scrambling the tiny proteins inside the brain to zapping it with electrical or magnetic pulses, those who experience migraine have never had as many ways of combating this painful, debilitating condition. And new research means there are more on the horizon. But how far are we from beating migraine for good?

"It's a pretty amazing time to treat migraine at this point," says Narayan Kissoon, a neurologist at Mayo Clinic in Minnesota, in the US. "When I started my practice a little over a decade ago, the treatments that I had to offer then were just a fraction of what I have now."

Even so, treating migraine still remains difficult. It is the second most prevalent cause of disability in the world, yet it feels different for everybody.

Most patients have some form of headache on one side of the head. It can be pulsing, thudding, stinging, or blunt. Some people experience nausea and vomiting, sensitivity to light, sound, smell and movement. In 25% of cases, a shapeshifting light leak into their field of vision known as aura.

Three-quarters of migraine patients are women. And while most migraine patients are adults, children can get it too – with some experiencing it as an intense stomach ache. 

"There's not really a kind of objective measure for migraine," says Teshamae Monteith, chief of the headache division at the University of Miami Health System, in the US.

Why it's so hard to treat migraine

Since migraine patients sit on such a wide spectrum, treatment for the neurological condition is also hit or miss. While some immediately find relief, others can try multiple therapies to no avail. 

I am a migraine patient myself. I can mute an attack in its tracks with a simple over-the-counter painkiller like paracetamol or ibuprofen. Scientists have also developed more migraine-specific drugs that tighten up the brain's blood vessels, target serotonin receptors and quiet pain nerve fibres. And even though studies suggest two-thirds of patients can be pain-free after two hours of taking these medications, they don't work for me at all. 

There's a further complication – taking painkillers too often seems to exacerbate migraine, a phenomenon known as "medication overuse headache". And as migraine attacks tend to beget more migraine attacks, they can go from being episodic to chronic over time.

But it's not just about treating an attack mid-stride. Most patients prefer treatments that can keep attacks from occurring in the first place.

Over the decades, doctors have found a flurry of medications developed for other conditions – cardiac medication, antidepressants and anti-epileptic drugs – that also happen to prevent migraine, when dosages are tweaked. But these often come with strong side effects and not everybody responds to the same types of drugs.

Perhaps the most significant breakthrough in migraine treatment came when scientists eavesdropped on the molecules found in the blood vessels near the brain.

Molecules on the mind

In the early 1990s, scientists syringed blood from the jugular veins of 32 patients. The blood, which was returning towards the heart after circulating through the brain, was awash with a flurry of protein fragments called calcitonin gene-related peptides, or CGRPs.

CGRPs are small proteins that act like dimmer switches to dial neuron activity and sensitivity up or down. During a migraine attack, they appear in high concentrations, buzzing all over the neuron cells and heightening their sensitivity, says Debbie Hay, professor of pharmacology and toxicology at the University of Otago, in New Zealand.

Studies suggest that CGRPs are higher in the blood of people who get migraine, even when they're not having an attack. Scientists have also induced migraine attacks by injecting patients with extra CGRPs.

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Blocking CGRPs can help stop an ongoing migraine attack by reducing signalling and resetting that hypersensitivity, says Hay. While this doesn't necessarily mean these peptides are the root cause of migraine, they are a tangible biological mechanism to dampen the excessive signals causing thesymptoms.

"That's essentially what it comes down to – where's the on switch, and where's the off switch?" says Amynah Pradhan, director of the center for clinical pharmacology at Washington University in St Louis, in the US.

Thanks to the discovery of this mechanism, eight CGRP-targeting drugs are on the market: some use antibodies that mop up all of the CGRP in the blood and some stop the peptides from triggering nerve cells.

"These have definitely been a real boon for migraine patients," says Pradhan. "It has expanded the toolbox of solutions."

One 2025 study found that 70% of people on CGRP for a year saw their migraine attacks drop by 75% in frequency, while 23% of them got rid of their attacks completely. Another study by the same team found that the proportion of people who found relief from CGRP therapies increased progressively over the years: after the first year, about 50% of patients saw their attacks halve, but after three years, 70% of patients did. But they are not quite the wonder drugs they might seem. A 2020 review of 11 separate studies on over 4,000 patients found that patients, on average, experienced just 1.5 fewer days of migraine a month. 

In Daniels' case, CGRP blockers gave her relief from her migraines for six months, but then they came back with a vengeance. Daniels suffers from vestibular migraine, which means an attack also scrambles her ability to balance. 

She had such bad chronic migraine that she could barely leave the house. It left her in "excruciating pain", she says. "I couldn't walk in a straight line, I couldn't drive, I couldn't leave the house at all," she says. "It was really horrific."

It is a common issue for many migraine sufferers. While some patients benefit so greatly from CGRP treatments they have become known as "super-responders" others get no benefit at all.

New drugs on the horizon

Yet, the discovery of CGRPs is paving the way for a new class of drugs.

Other neuropeptides, such Pacap, or pituitary adenylate cyclase-activating polypeptide, have been found to play a role in migraine and offer tantalising targets for drugs. Despite being a different class of peptides that bind to a different set of receptors on neurons, injecting migraine patients with Pacap tends to spark an attack, while Pacap antibodies provide relief.

It appears there could be several molecular on and off switches to migraine, says Pradhan. 

Others such as vasoactive intestinal polypeptide, and peptides that are involved in the sleep mechanism, so-called orexins, are the targets of new drugs currently undergoing clinical trials.

"The peptide story is pretty hot," says Peter Goadsby, professor of neurology at King's College London, in the UK. Crucially, these peptide-based drugs don't just work to stop attacks that are ongoing, but they can also be used as preventative medicines to help prevent them from arising in the first place. Most migraine treatments tend to do one or the other.

"These drugs have not only provided therapeutic advances," says Goadsby. "But they've actually called on us to think out of the box and evolve our thinking quite a lot."

Out-of-the-box treatments

Another recent development emerged from a realisation that a product more commonly used for cosmetic purposes could bring relief for those with migraine. 

Botox uses a toxin produced by the botulinum bacterium. Migraine patients who receive a course of injections of the toxin see a reduction in migraine frequency.

It is one of the "more effective things we have to offer patients", says Kissoon. He administers his patients with 25-to-33 injections around the head and neck for two or three times over the course of a year.

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At first, scientists thought that patients who came for cosmetic Botox were finding their headaches improved because the toxin made their face and head muscles relax. But further research revealed that the injections actually block the CGRP released in the sensory nerve fibres.

In some cases, patients with chronic migraine see a reduction in migraine frequency by at least 50%. Intriguingly, the treatment even seems to lead to structural changes to their brain as patients find relief. (Of course, Botox for migraine should be administered by migraine specialists to ensure it is used safely.) 

Waves of relief

For people who do not respond to medication – or who cannot take many of them, like pregnant women – more mechanical migraine therapeutics are on the rise.

For one, neuromodulation devices use small electrical or magnetic pulses to massage and stimulate the nerves that are connected to headache pain. "It breaks up those pain pathways that have been firing and wiring together over the years and rewires and recalibrates them," says Kissoon.

Devices come in a variety of shapes, sizes and methods. Daniels uses a neck-massaging device that stimulates the vagus nerve. "It's a bit of a safety net for me," says Daniels, who initially bought her neuromodulation device but now receives some free products to use with it from the manufacturer in exchange for social media posts about her experience.

She uses it to stop an ongoing attack – by massaging herself three times in two-minute cycles – and as preventative care each day. By using it alongside some severe lifestyle changes, Daniels thinks her headache frequency and pain have gotten significantly better, as have her vestibular symptoms.

Other examples include forehead electrode pads, armbands and a crown-like device that all aim to stimulate nerves running to and inside the head.

While not a panacea for the neurological condition, many of these devices show promising results for large groups of patients, both for treating attacks and for preventing them.

"What they're targeting, I think, is still a little bit unclear," says Pradhan. "But I think they're fascinating and I think that they're another example of how the toolbox can be expanded." (All of these devices present a steep cost for access and they are not approved everywhere in the world.)

Patients with extreme migraine have even had electrodes implanted to stimulate the occipital nerves that extend over the back of the head. This approach, however, had dubious outcomes with many of the patients needing the electrodes removed or suffering infections or allergic reactions.

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Other scientists are developing a device that goes up a patient's nostril with a catheter and a vibrating balloon buzzes a migraine away. While the machine is supposed to target nerve cells buried behind the nose and the trigeminal nerve, in this case too it's unclear how pain is being disrupted. One theory is that the vibrating motion helps mute an attack by decreasing inflammation inside the meningeal membrane, the thick sack that protects the brain. 

The whole brain

But it is likely there is no one-size-fits-all approach to treating migraine, experts say.

"I like to think of the whole thing as a bookshelf," says Goadsby. "On the bookshelf, there are classic medicines, there are modern medicines, there's neuromodulation. We need to unpack which shelf you want to be on before we even decide which book you're going to read."

Some scientists also believe there needs to be a further shift in the way migraine is thought of – one that doesn't just look at molecules, membranes and blood vessels, but looks at the whole brain, even when an attack isn't happening.

"If we really talk about moving the field forward and improving quality of life, we must think that if you have a migraine brain, it's a chronic condition," says Monteith. Behavioural changes surrounding sleep hygiene, diet, and fitness regimes, as well as psychological therapies like cognitive behavioural therapy, relaxation therapy and mindfulness, are also being incorporated in a patient's journey to tame their migraine.

Daniels, for instance, does physical therapy for her vestibular symptoms, is on top of her mental health, stays active and works out every day, meditates and spends time in nature, and prioritises a healthy diet and a lot of hydration. No one thing helped alleviate her migraine symptoms, she says. "It is all part of the pieces of the puzzle."

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