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A Randomized, Sham-controlled Study of gammaCore ® (nVNS) for Prevention of Episodic Migraine

Primary Purpose

Migraine

Status
Completed
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
gammaCore®-R
gammaCore®-R Sham
Sponsored by
ElectroCore INC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Migraine

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Is between the ages of 18 and 75 years.
  2. Has been previously diagnosed with migraine (with or without aura) in accordance with the International Classification of Headache Disorders (ICHD)-3 Beta Classification criteria.
  3. Experience between 5 and 12 migraine days per month (over the last 4 months) with at least 2 of the migraines lasting more than 4 hours.
  4. Has age of onset of migraine less than 50 years old.
  5. Agrees not to use any migraine prevention treatments (including Botox injections) and/or medications (exclusive of medications taken for acute relief of migraine symptoms).
  6. Agrees to refrain from initiating or changing the type, dosage or frequency of any prophylactic medications for indications other than migraine that in the opinion of the clinician may interfere with the study objectives (e.g. antidepressant, anti convulsant, beta blockers, etc.).
  7. Agrees to use the gammaCore®-R device as intended, follow all of the requirements of the study including follow-up visit requirements, record required study data in the subject dairy, and other self-assessment questionnaires.
  8. Is able to provide written Informed Consent.

Exclusion Criteria:

  1. Has a concomitant medical condition that will require oral or injectable steroids during the study.
  2. Has a history of any intracranial aneurysm, intracranial haemorrhage, brain tumour or significant head trauma.
  3. Has a structural abnormality at the gammaCore®-R treatment site (e.g lymphadenopathy previous surgery or abnormal anatomy).
  4. Has pain at the gammaCore®-R treatment site (e.g.dysesthesia, neuralgia and/or cervicalgia).
  5. Has other significant pain problem (e.g.cancer pain, fibromyalgia or other head or facial disorder) that in the opinion of the investigator may confound the study assessments
  6. Has know or suspected severe cardiac disease(e.g. symptomatic coronary artery disease, prior myocardial infarction, congestive heart failure (CHF)).
  7. Has known or suspected severe cerebrovascular disease, (e.g. prior stroke or transient ischemic attack, symptomatic carotid artery disease, prior carotid endarterectomy or other vascular neck surgery).
  8. Has an abnormal baseline Electrocardiogram (ECG) e.g. second and third degree heart block, prolonged QT interval, atrial fibrillation, atrial flutter, history of ventricular tachycardia or ventricular fibrillation, or clinically significant premature ventricular contraction).
  9. Has had a cervical vagotomy.
  10. Has uncontrolled high blood pressure (systolic >160 diastolic > 100 after 3 repeated measurements within 24 hours).
  11. Is currently implanted with an electrical and/or neurostimulator device (e.g. cardiac pacemaker or defibrillator, vagal neurostimulator, deep brain stimulator, spinal stimulator, bone growth stimulator cochlear implant, Sphenopalatine ganglion stimulator or Occipital nerve stimulator).
  12. Has been implanted with metal cervical spine hardware or has a metallic implant near the gammaCore®-R stimulation site.
  13. Has a known history of suspicion of secondary headache.
  14. Has a history of syncope (within the last five years).
  15. Has a history of seizures (within the last five years).
  16. Has a known or suspicion of substance abuse or addiction (within the last 5 years).
  17. Is using marijuana (including medical marijuana) for any indications, more than twice a month.
  18. Currently takes simple analgesics or non-steroidal anti-inflammatory drugs (NSAIDs) greater than 15 days per month or triptans, ergots or combined analgesics greater than 10 days per month for headaches or other body pain.
  19. Currently takes prescription opioids greater than 2 days per month for headaches or body pain.
  20. Has taken medications for migraine prophylaxis in the previous 30 days.
  21. Has previous diagnosis of medication overuse headache (MoH) , which has reverted to episodic migraine within the last 6 months.
  22. Meets the ICHD-3 Beta Classification criteria for chronic migraine (> 15 headache days per month).
  23. Has failed an adequate trial (two months or greater) of at least 3 classes of a drug therapy for the prophylaxis of migraine .
  24. Has had surgery for migraine prevention.
  25. Has undergone nerve block (occipital or other) in the head or neck within the last 2 months.
  26. Has received Botox injections within the last 6 months.
  27. Is pregnant or thinking of becoming pregnant during the study period, or of childbearing years and is unwilling to use and accepted form of birth control.
  28. Is participating in any other therapeutic clinical investigation or has participated in a clinical trial in the preceding 30 days.
  29. Belongs to a vulnerable population or has any condition such that his or her ability to provide informed consent, comply with the follow-up requirements, or provide self- assessments is compromised (e.g. homeless, developmentally disabled and prisoner).
  30. Is a relative of or an employee of the investigator or the clinical study site.
  31. Has psychiatric or cognitive disorder and/or behavioural problems which in the opinion of the clinician may interfere with the study.
  32. Has previously used the gammaCore® device.

Sites / Locations

  • Neurology Department, University of Liège
  • Danish Headache Center
  • Neurologische Klinik und Poliklinik, Charité Campus Mitte
  • Klinik für Neurologie, Universitätsklinikum Essen
  • CTC, University Medical Center Hamburg-Eppendorf
  • Migräne- und Kopfschmertzklinik Königstein
  • Klinik für Neurologie, Ludwig-Maximilliams-Universität, Klinikum Grosshadern
  • Zentrum für Neurologie und Epileptologie, Hertie-Institut für Klinische Hirnforschung
  • DKD HELIOS Klinik Wiesbaden
  • Neurology Department, Athens Naval Hospital
  • Neurology Department, Leiden University Center
  • Sandvika Nevrosenter AS
  • Headache Unit, University Hospital Vall d'Hebron
  • Servicio de Neurologia, Hospital Ruber Internacional
  • Servicio de Neurologia, Clinica Universidad de Navarra
  • Servicio de Neurologia, Hospital Clinico Universitario de Valencia
  • Basildon University Hospital
  • School of Clinical and Expermental Medicine
  • Neurology Department, The Southern Hospital
  • Neurology Department, Hull Royal Infirmary
  • Neurology Department, The Walton Center
  • Neurology Department, King's College London

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Sham Comparator

Arm Label

gammaCore®-R

gammaCore®-R Sham

Arm Description

Subjects will be instructed to treat three times per day, 2 consecutive bilateral stimulations, upon waking, six to eight hours following the first daily treatment, and six to eight hours following the second daily treatment (one stimulation on the right side immediately followed by a second stimulation on the left side).

Subjects will be instructed to treat three times per day, 2 consecutive bilateral stimulations, upon waking, six to eight hours following the first daily treatment, and six to eight hours following the second daily treatment (one stimulation on the right side immediately followed by a second stimulation on the left side).

Outcomes

Primary Outcome Measures

Change in the Number of Migraine Days
Change in number of migraine days (as reported in subject diary), comparing the 4 week run-in period to the last 4 weeks in the randomized period.

Secondary Outcome Measures

Number of Participants With 50% Responder Rate
The number of subjects with a reduction of 50% or more in number of migraine days (as reported in the subject diary) from the run-in period to the last 4 weeks of the double-blind period.
Mean Change in Number of Headache Days
The mean change in number of headache days (as reported in the subject diary) from the run-in period to the last 4 weeks of the double-blind period.
Change in Number of Acute Medication Days
The mean change in number of acute medication days (as reported in the subject diary) from the run-in period to the last 4 weeks of the double-blind period
Change in Headache Disability Using Headache Impact Test-6
Change in headache disability from the 4 week run-in period to the last 4 weeks of the randomized period as measured using the Headache Impact Test-6 (HIT-6). The HIT-6 measures the impact if a subject's headaches on their ability to function at work, at home and in social situations. Subjects are presented with 6 questions about ability to function and normal daily life and for each question they rate the impact of their headaches as 'never' (6 points) or 'rarely' (9 points) or 'sometimes' (10 points) or 'very often' (11 points) or 'always' (13 points). Minimum score = 36, maximum score = 78. A higher score indicates more impact.
Number of Participants According to Grade on the Migraine Disability Assessment (MIDAS) Before and After Randomized Period
Migraine Disability Assessment (MIDAS) score from the end of run-in period to the end of randomized period. The MIDAS assessment measures the effect of headaches on a subject's daily functioning. It takes into account the past 3 months and is comprised of five questions. A lower score indicated less disability, a higher score indicates more disability. The scores are graded: 0-5, MIDAS Grade I, little disability 6-10, MIDAS Grade II, mild disability 11 to 20 MIDAS Grade III, moderate disability 21+ MIDAS Grade IV, severe disability
Compare Changes in Quality of Life EuroQol Questionnaire 5 Dimensions and 5 Levels (EQ-5D-5L)
The descriptive system comprises five dimensions (5D): mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels (5L): no problems (1) , slight problems (2), moderate problems (3), severe problems (4) and extreme problems (5). Minimum score is 5 (no problems) and maximum score is 25 (extreme problems) An overall health question is asked using a visual analogue scale(VAS) from 0-100 where 0 is bad health and 100 good health
Change in Migraine Days in the Open Label Period (Adjusted ANCOVA)
Change in number of migraine days (as reported in subject diary) during the 6 month open label period compared to the baseline run-in period.
Number of Participants With Adverse Events
Adverse Effects were collected for all subjects for the duration of the study.
Change in Headache Days in the Open Label Period
The mean change in number of headache days (as reported in the subject diary) during the open label period compared to the base-line run-in period

Full Information

First Posted
February 18, 2015
Last Updated
July 14, 2019
Sponsor
ElectroCore INC
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1. Study Identification

Unique Protocol Identification Number
NCT02378844
Brief Title
A Randomized, Sham-controlled Study of gammaCore ® (nVNS) for Prevention of Episodic Migraine
Official Title
A Randomized, Multicentre, Double-blind, Parallel, Sham-controlled Study of gammaCore®, a Non-invasive Vagal Nerve Stimulator (nVNS), for Prevention of Episodic Migraine
Study Type
Interventional

2. Study Status

Record Verification Date
July 2019
Overall Recruitment Status
Completed
Study Start Date
June 2015 (Actual)
Primary Completion Date
February 1, 2018 (Actual)
Study Completion Date
August 29, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
ElectroCore INC

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
A prospective, double-blind, randomized, sham-controlled, multicentre investigation.
Detailed Description
The study period will begin with a four week run-in period, during which there is no investigational treatment. The purpose of the run-in period will be observation for baseline comparison. The run-in period will be, followed by a 12 week randomized period when the subjects will be randomized (1:1) to either active treatment or sham (inactive) treatment. The randomized period will be followed by a 24 week open label period, where the subjects in the sham treatment group will switch in treatment assignment and receive a gammaCore®-R and the gammaCore®-R will continue to receive an active treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Migraine

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
477 (Actual)

8. Arms, Groups, and Interventions

Arm Title
gammaCore®-R
Arm Type
Active Comparator
Arm Description
Subjects will be instructed to treat three times per day, 2 consecutive bilateral stimulations, upon waking, six to eight hours following the first daily treatment, and six to eight hours following the second daily treatment (one stimulation on the right side immediately followed by a second stimulation on the left side).
Arm Title
gammaCore®-R Sham
Arm Type
Sham Comparator
Arm Description
Subjects will be instructed to treat three times per day, 2 consecutive bilateral stimulations, upon waking, six to eight hours following the first daily treatment, and six to eight hours following the second daily treatment (one stimulation on the right side immediately followed by a second stimulation on the left side).
Intervention Type
Device
Intervention Name(s)
gammaCore®-R
Intervention Description
Subjects will be instructed to treat three times per day, 2 consecutive bilateral stimulations, upon waking, six to eight hours following the first daily treatment, and six to eight hours following the second daily treatment (one stimulation on the right side immediately followed by a second stimulation on the left side).
Intervention Type
Device
Intervention Name(s)
gammaCore®-R Sham
Intervention Description
Subjects will be instructed to treat three times per day, 2 consecutive bilateral stimulations, upon waking, six to eight hours following the first daily treatment, and six to eight hours following the second daily treatment (one stimulation on the right side immediately followed by a second stimulation on the left side).
Primary Outcome Measure Information:
Title
Change in the Number of Migraine Days
Description
Change in number of migraine days (as reported in subject diary), comparing the 4 week run-in period to the last 4 weeks in the randomized period.
Time Frame
last 4 weeks of the randomized/controlled period compared to the subject's own 4-week run-in period.
Secondary Outcome Measure Information:
Title
Number of Participants With 50% Responder Rate
Description
The number of subjects with a reduction of 50% or more in number of migraine days (as reported in the subject diary) from the run-in period to the last 4 weeks of the double-blind period.
Time Frame
The last four weeks in the randomization period compared to the four week run-in period.
Title
Mean Change in Number of Headache Days
Description
The mean change in number of headache days (as reported in the subject diary) from the run-in period to the last 4 weeks of the double-blind period.
Time Frame
The last four weeks in the randomization period compared to the four week run-in period.
Title
Change in Number of Acute Medication Days
Description
The mean change in number of acute medication days (as reported in the subject diary) from the run-in period to the last 4 weeks of the double-blind period
Time Frame
The last four weeks in the randomization period compared to the four week run-in period.
Title
Change in Headache Disability Using Headache Impact Test-6
Description
Change in headache disability from the 4 week run-in period to the last 4 weeks of the randomized period as measured using the Headache Impact Test-6 (HIT-6). The HIT-6 measures the impact if a subject's headaches on their ability to function at work, at home and in social situations. Subjects are presented with 6 questions about ability to function and normal daily life and for each question they rate the impact of their headaches as 'never' (6 points) or 'rarely' (9 points) or 'sometimes' (10 points) or 'very often' (11 points) or 'always' (13 points). Minimum score = 36, maximum score = 78. A higher score indicates more impact.
Time Frame
From four week run-in period to last four weeks in the randomization period
Title
Number of Participants According to Grade on the Migraine Disability Assessment (MIDAS) Before and After Randomized Period
Description
Migraine Disability Assessment (MIDAS) score from the end of run-in period to the end of randomized period. The MIDAS assessment measures the effect of headaches on a subject's daily functioning. It takes into account the past 3 months and is comprised of five questions. A lower score indicated less disability, a higher score indicates more disability. The scores are graded: 0-5, MIDAS Grade I, little disability 6-10, MIDAS Grade II, mild disability 11 to 20 MIDAS Grade III, moderate disability 21+ MIDAS Grade IV, severe disability
Time Frame
3 months - end of run-in period to end of randomized period
Title
Compare Changes in Quality of Life EuroQol Questionnaire 5 Dimensions and 5 Levels (EQ-5D-5L)
Description
The descriptive system comprises five dimensions (5D): mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels (5L): no problems (1) , slight problems (2), moderate problems (3), severe problems (4) and extreme problems (5). Minimum score is 5 (no problems) and maximum score is 25 (extreme problems) An overall health question is asked using a visual analogue scale(VAS) from 0-100 where 0 is bad health and 100 good health
Time Frame
From four week run-in period to last four weeks in the randomization period
Title
Change in Migraine Days in the Open Label Period (Adjusted ANCOVA)
Description
Change in number of migraine days (as reported in subject diary) during the 6 month open label period compared to the baseline run-in period.
Time Frame
The 6 month open-label period compared to the four week run-in period
Title
Number of Participants With Adverse Events
Description
Adverse Effects were collected for all subjects for the duration of the study.
Time Frame
up to Week 36
Title
Change in Headache Days in the Open Label Period
Description
The mean change in number of headache days (as reported in the subject diary) during the open label period compared to the base-line run-in period
Time Frame
The 6 month open-label period compared to the four week run-in period

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Is between the ages of 18 and 75 years. Has been previously diagnosed with migraine (with or without aura) in accordance with the International Classification of Headache Disorders (ICHD)-3 Beta Classification criteria. Experience between 5 and 12 migraine days per month (over the last 4 months) with at least 2 of the migraines lasting more than 4 hours. Has age of onset of migraine less than 50 years old. Agrees not to use any migraine prevention treatments (including Botox injections) and/or medications (exclusive of medications taken for acute relief of migraine symptoms). Agrees to refrain from initiating or changing the type, dosage or frequency of any prophylactic medications for indications other than migraine that in the opinion of the clinician may interfere with the study objectives (e.g. antidepressant, anti convulsant, beta blockers, etc.). Agrees to use the gammaCore®-R device as intended, follow all of the requirements of the study including follow-up visit requirements, record required study data in the subject dairy, and other self-assessment questionnaires. Is able to provide written Informed Consent. Exclusion Criteria: Has a concomitant medical condition that will require oral or injectable steroids during the study. Has a history of any intracranial aneurysm, intracranial haemorrhage, brain tumour or significant head trauma. Has a structural abnormality at the gammaCore®-R treatment site (e.g lymphadenopathy previous surgery or abnormal anatomy). Has pain at the gammaCore®-R treatment site (e.g.dysesthesia, neuralgia and/or cervicalgia). Has other significant pain problem (e.g.cancer pain, fibromyalgia or other head or facial disorder) that in the opinion of the investigator may confound the study assessments Has know or suspected severe cardiac disease(e.g. symptomatic coronary artery disease, prior myocardial infarction, congestive heart failure (CHF)). Has known or suspected severe cerebrovascular disease, (e.g. prior stroke or transient ischemic attack, symptomatic carotid artery disease, prior carotid endarterectomy or other vascular neck surgery). Has an abnormal baseline Electrocardiogram (ECG) e.g. second and third degree heart block, prolonged QT interval, atrial fibrillation, atrial flutter, history of ventricular tachycardia or ventricular fibrillation, or clinically significant premature ventricular contraction). Has had a cervical vagotomy. Has uncontrolled high blood pressure (systolic >160 diastolic > 100 after 3 repeated measurements within 24 hours). Is currently implanted with an electrical and/or neurostimulator device (e.g. cardiac pacemaker or defibrillator, vagal neurostimulator, deep brain stimulator, spinal stimulator, bone growth stimulator cochlear implant, Sphenopalatine ganglion stimulator or Occipital nerve stimulator). Has been implanted with metal cervical spine hardware or has a metallic implant near the gammaCore®-R stimulation site. Has a known history of suspicion of secondary headache. Has a history of syncope (within the last five years). Has a history of seizures (within the last five years). Has a known or suspicion of substance abuse or addiction (within the last 5 years). Is using marijuana (including medical marijuana) for any indications, more than twice a month. Currently takes simple analgesics or non-steroidal anti-inflammatory drugs (NSAIDs) greater than 15 days per month or triptans, ergots or combined analgesics greater than 10 days per month for headaches or other body pain. Currently takes prescription opioids greater than 2 days per month for headaches or body pain. Has taken medications for migraine prophylaxis in the previous 30 days. Has previous diagnosis of medication overuse headache (MoH) , which has reverted to episodic migraine within the last 6 months. Meets the ICHD-3 Beta Classification criteria for chronic migraine (> 15 headache days per month). Has failed an adequate trial (two months or greater) of at least 3 classes of a drug therapy for the prophylaxis of migraine . Has had surgery for migraine prevention. Has undergone nerve block (occipital or other) in the head or neck within the last 2 months. Has received Botox injections within the last 6 months. Is pregnant or thinking of becoming pregnant during the study period, or of childbearing years and is unwilling to use and accepted form of birth control. Is participating in any other therapeutic clinical investigation or has participated in a clinical trial in the preceding 30 days. Belongs to a vulnerable population or has any condition such that his or her ability to provide informed consent, comply with the follow-up requirements, or provide self- assessments is compromised (e.g. homeless, developmentally disabled and prisoner). Is a relative of or an employee of the investigator or the clinical study site. Has psychiatric or cognitive disorder and/or behavioural problems which in the opinion of the clinician may interfere with the study. Has previously used the gammaCore® device.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hans-Christoph Diener, Professor
Organizational Affiliation
Universtätsklinikum Essen
Official's Role
Principal Investigator
Facility Information:
Facility Name
Neurology Department, University of Liège
City
Liège
ZIP/Postal Code
BE-4000
Country
Belgium
Facility Name
Danish Headache Center
City
Glostrup
ZIP/Postal Code
DK-2600
Country
Denmark
Facility Name
Neurologische Klinik und Poliklinik, Charité Campus Mitte
City
Berlin
ZIP/Postal Code
D-10117
Country
Germany
Facility Name
Klinik für Neurologie, Universitätsklinikum Essen
City
Essen
ZIP/Postal Code
D-45147
Country
Germany
Facility Name
CTC, University Medical Center Hamburg-Eppendorf
City
Hamburg
ZIP/Postal Code
D-20251
Country
Germany
Facility Name
Migräne- und Kopfschmertzklinik Königstein
City
Königstein
ZIP/Postal Code
D-61462
Country
Germany
Facility Name
Klinik für Neurologie, Ludwig-Maximilliams-Universität, Klinikum Grosshadern
City
München
ZIP/Postal Code
D-81377
Country
Germany
Facility Name
Zentrum für Neurologie und Epileptologie, Hertie-Institut für Klinische Hirnforschung
City
Tübingen
ZIP/Postal Code
72076
Country
Germany
Facility Name
DKD HELIOS Klinik Wiesbaden
City
Wiesbaden
ZIP/Postal Code
D-65191
Country
Germany
Facility Name
Neurology Department, Athens Naval Hospital
City
Athens
ZIP/Postal Code
GR-11521
Country
Greece
Facility Name
Neurology Department, Leiden University Center
City
Leiden
ZIP/Postal Code
NL-2333 ZA
Country
Netherlands
Facility Name
Sandvika Nevrosenter AS
City
Sandvika
ZIP/Postal Code
N-1300
Country
Norway
Facility Name
Headache Unit, University Hospital Vall d'Hebron
City
Barcelona
ZIP/Postal Code
08035
Country
Spain
Facility Name
Servicio de Neurologia, Hospital Ruber Internacional
City
Madrid
ZIP/Postal Code
28034
Country
Spain
Facility Name
Servicio de Neurologia, Clinica Universidad de Navarra
City
Pamplona
ZIP/Postal Code
ES-31008
Country
Spain
Facility Name
Servicio de Neurologia, Hospital Clinico Universitario de Valencia
City
Valencia
ZIP/Postal Code
ES-46010
Country
Spain
Facility Name
Basildon University Hospital
City
Basildon
State/Province
Essex
ZIP/Postal Code
SS16 5NL
Country
United Kingdom
Facility Name
School of Clinical and Expermental Medicine
City
Birmingham
ZIP/Postal Code
B15 2TT
Country
United Kingdom
Facility Name
Neurology Department, The Southern Hospital
City
Glasgow
ZIP/Postal Code
G51 4TF
Country
United Kingdom
Facility Name
Neurology Department, Hull Royal Infirmary
City
Hull
ZIP/Postal Code
HU3 2JZ
Country
United Kingdom
Facility Name
Neurology Department, The Walton Center
City
Liverpool
ZIP/Postal Code
L9 7LJ
Country
United Kingdom
Facility Name
Neurology Department, King's College London
City
London
ZIP/Postal Code
SE5 9PJ
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
Results from the whole study will published but not individual participant data.
Citations:
PubMed Identifier
31522546
Citation
Diener HC, Goadsby PJ, Ashina M, Al-Karagholi MA, Sinclair A, Mitsikostas D, Magis D, Pozo-Rosich P, Irimia Sieira P, Lainez MJ, Gaul C, Silver N, Hoffmann J, Marin J, Liebler E, Ferrari MD. Non-invasive vagus nerve stimulation (nVNS) for the preventive treatment of episodic migraine: The multicentre, double-blind, randomised, sham-controlled PREMIUM trial. Cephalalgia. 2019 Oct;39(12):1475-1487. doi: 10.1177/0333102419876920. Epub 2019 Sep 15.
Results Reference
derived

Learn more about this trial

A Randomized, Sham-controlled Study of gammaCore ® (nVNS) for Prevention of Episodic Migraine

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