Practice-Based Consensus Amongst Indian Neurologists: Adopting Remote Electrical Neuromodulation for Effective Management of Migraine.

INTRODUCTION

Migraine is a major cause of disability in India, disproportionately affecting women and adolescents. Although traditional pharmacological treatments exist, side effects and poor adherence have increased interest in non-pharmacological options such as remote electrical neuromodulation (REN). However, clinical adoption of REN remains limited because of the absence of clear, India-specific guidelines.

METHODS

An Indian consensus was developed through a two-phase Delphi process involving 49 neurologists. Phase 1 included a scientific committee of eight neurologists who conducted a targeted literature review on REN and formulated 27 consensus statements. In phase 2, 41 neurologists from across India participated in modified Delphi rounds to finalize these statements.

RESULTS

Statements achieving over 60% agreement identified REN as a promising and well-tolerated non-pharmacological therapy that addresses limitations of current migraine treatments. High consensus (75-97.22%) highlighted REN's favorable safety profile, minimal adverse events, and suitability for adolescents and women of childbearing age.

CONCLUSION

This Indian consensus provides practical guidance for integrating REN into migraine management. The REN device shows potential as a first-line or adjunct therapy, particularly for patients facing challenges with pharmacological treatment adherence, supporting its wider adoption in clinical practice.