The cover story of the October 7, 2002 issue of TIME simply suggests there is "new hope" in the prevention of headaches.  Unfortunately, the story was a re-hash of the current state of affairs in the pharmaceutically supported headache and migraine management industry.

Presented as the most encouraging research was the anti-epilepsy drug topiramate. From the article: Dr. Stephen Silberstein of Thomas Jefferson University in Philadelphia presented a study of nearly 500 patients showing that topiramate significantly reduced both the occurrence and duration of migraines—offering hope that a whole class of existing antiseizure drugs could someday help migraine sufferers put an end to attacks before they occur.  No mention was made as to the side effects of topiramate.  In its clinical trials, for example, 28% of subjects taking topriamate had to drop out of the study because the side-effects were intolerable.

The most revealing aspect of the article was the observation of the trigeminal nerve, a complex network of nerve fibers that ferries sensory signals from the face, jaws and top of the forehead to the brain. During the course of a migraine, scientists discovered, the trigeminal nerve practically floods the brain with pain signals. The more researchers learn about the trigeminal nerve, the more they believe that it is involved in all types of primary headaches, including tension and cluster headaches. The differences in the headache types seem to stem from what activates the trigeminal nerve and how it responds.   

The hypothesis for the method of action of the NTI device for headache and migraine prevention involves both the trigeminal nerve and the sympathetic nervous system.  Specifically, when hyperactive spindle fibers (which are innervated by the sympathetic nervous system) reside within a trigeminally innervated muscle (like the temporalis, for example), a sympathetic input (that is, a "trigger"), may cause the intrafusal fibers of the spindle to contort or spasm.   One of the effect of the NTI device is described by it's name, NTI: Nociceptive Trigeminal Inhibition (meaning inhibitory signals are sent to disrupt trigeminal activity).  Currently, the only known method of disrupting hyper-trigeminal activity is with the NTI device.  As the TIME article describes, What seems clear, however, is that the brain of a migraineur (as sufferers are called) is primed to overreact to all sorts of stimuli that most people can easily tolerate. "The brain receives input from a wide variety of triggers—stress, hormones, falling barometric pressure, food, drink, sleep disturbances," says Dr. David Buchholz, a neurologist at the Johns Hopkins University School of Medicine in Baltimore, Md. "Each of us has his own stack of triggers and his own personal threshold at which the migraine mechanism activates. The higher the trigger level climbs above the threshold, the more fully activated the migraine system—and the more pain", which perfectly describes a heightened sympathetic tone, as is seen in the spindle fibers of migraine and headache sufferers.  

There was no mention of the NTI device, the only non-drug, non-surgical method approved for marketing by the FDA for the prevention of medically diagnosed migraine pain.  However, Botox was mentioned, but curiously, as a "surprise": One of the surprises of the past couple of years is the effectiveness of Botox, which is now being injected into facial muscles to temporarily erase wrinkles. Migraineurs have reported that botox seems to banish their headaches as well. Studies are under way to see if those observations hold up.   Botox studies continue to show efficacy in migraine prevention (results vary greatly, due mostly to an unstandardized protocol of injection placement).  One of the leading hypotheses of the efficacy of Botox involves "re-normalization of excessive muscle spindle activity".

As more is learned and accepted by the pharmaceutically supported migraine and headache management industry about the trigeminal and sympathetic nervous system, "alternative" modalities such as the NTI may become more widely accepted.