The Migraine Zapper
Therapeutic magnetic stimulation for migraine has received widespread attention. One device—a transcranial magnetic stimulator nicknamed the migraine zapper—has been approved by the FDA as an investigational medical device. But what about other forms of external stimulation, such as electrical currents or light pulses? Should we be inventing migraine frizzlers and scintillators too—or does that verge on fringe science?
There’s reason to take the idea seriously. Applying transcranial stimulation at the onset of a migraine may abort the attack or significantly reduce its severity in some patients. This approach is currently being tested in randomized, sham-controlled trials designed to evaluate both safety and efficacy as an add-on therapy.
I think the concept is compelling. But what matters most, in my view, is not just the device itself, but the stimulation technique—the software that drives it. Just as a single computer can run different operating systems (Windows, macOS, or Linux), a neurostimulation device can be programmed in many ways. As we all know, software can make all the difference.
Migraine Frizzlers and Scintillators?
Why stop at magnetic stimulation? Other pathways into the brain might also be worth exploring. For instance, animal data (Liebetanz et al., Neurosci. Lett. 398, 2006) suggests that anodal transcranial direct current stimulation (tDCS)—which increases cortical excitability—can provoke migraine attacks, even after the stimulation ends. But techniques derived from chaos control theory suggest that the very same method could be inverted to prevent an attack (Dahlem et al., Chaos 18, 2008). That would turn the tDCS device into a migraine frizzler rather than a zapper.
Even simpler still: light. Flashing light at certain frequencies—both spatial and temporal—is known to elevate cortical excitability. In fact, it can be used to trigger an attack in sensitive individuals. But if we can provoke it, why not reverse it? A carefully tuned sequence of light pulses—the migraine scintillator—might one day help abort or at least ease the severity of an attack.
I firmly believe that external stimulation, if properly configured, could work both ways: either as a trigger or as a therapeutic.
From Bifurcation to Bench and Bedside
My vision for this research is one I’ve often summarized as:
From bifurcation to bench and bedside.
I aim to understand neurological disorders like migraine—but also stroke and epilepsy—as emergent transient states near nonequilibrium phase transitions in the brain. In nonlinear dynamics, such transitions are called bifurcations.
Once we grasp these theoretical principles, they can guide how we program therapeutic devices—like the one featured in the video.
As Vivien Williams puts it in the clip (the clip is not available anymore):
“It’s like something you’d see on Star Trek.”
But a real-world therapeutic mission will still take time. Perhaps five years—or more. We’ll need to explore strange new therapies and boldly go where no treatment has gone before. This kind of innovation can likely only be achieved through international, multi-center collaborations that bring together both clinical and basic scientists—working side by side on migraine and feedback-based interventions.