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A Study to Evaluate the Efficacy and Safety of Eptinezumab Administered Intravenously in Participants Experiencing Acute Attack of Migraine (RELIEF)

Primary Purpose

Migraine

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Eptinezumab
Placebo
Sponsored by
H. Lundbeck A/S
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Migraine

Eligibility Criteria

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

Inclusion Criteria:

  • Greater than 1-year history of migraine, with or without aura, with onset of first migraine before age 50.
  • Migraine on 4 to 15 days per month in the 3 months prior to screening.
  • Headache free for at least 24 hours prior to onset of a qualifying migraine.

Exclusion Criteria:

  • Unable to differentiate migraine from other headache or pain disorders.
  • Use of the following medication, for any indication, within the 24-hour period prior to dosing with study drug:

    1. triptans, ergotamines and ergot-derivatives
    2. analgesics (including but not limited to acetaminophen, tramadol, nonsteroidal anti-inflammatory drugs [NSAIDs], combination analgesics, caffeine-containing analgesics, and opioids/narcotics) and other acute migraine medication(s)
    3. antiemetic medications (including but not limited to prochlorperazine, promethazine, droperidol, chlorpromazine, metoclopramide)
    4. antihistamines
    5. devices, neuromodulation, neurostimulation, or injectable therapy (trigger point injections, extracranial nerve blocks, facet joint injections, spinal manipulation)
  • Use of the following medication, for any indication, in each of the 3 months prior to screening:

    1. opioids/narcotics or butalbital containing products (including combinations) on more than 4 days per month;
    2. triptans, ergotamines, or combination analgesics for 10 or more days per month;
    3. acetaminophen, aspirin or NSAIDs for 15 or more days per month (except if participant is taking 81 mg dose of aspirin for cardiac prophylaxis)
  • History or diagnosis of chronic tension-type headache, hypnic headache, cluster headache, hemicrania continua, new daily persistent headache, or unusual migraine subtypes such as hemiplegic migraine (sporadic and familial), ophthalmoplegic migraine and migraine with neurological accompaniments that are not typical of migraine aura (for example, diplopia, altered consciousness, or long duration).
  • Any changes to preventive migraine treatment(s) within 1 month prior to screening and up to treatment with the study drug (Day 0).
  • Any use of approved devices, neuromodulation, neurostimulation, or injectable therapy (trigger point injections, extracranial nerve blocks, facet joint injections) within the 24-hour period prior to treatment with study drug (Day 0).
  • Any use of botulinum toxin for migraine or for any other medical/cosmetic reasons requiring injections within 7 days prior to treatment with study drug (Day 0).
  • Any use of systemic corticosteroid for migraine or any other reason within 3 months prior to treatment with study drug (Day 0).
  • Evidence or medical history of clinically significant psychiatric diseases that are uncontrolled and/or untreated.
  • Receipt of any monoclonal antibody treatment, for migraine or any other indication, (within or outside a clinical study) within 6 months prior to screening.

Sites / Locations

  • Alabama Clinical Therapeutics
  • Arizona Research Center
  • Baptist Health Center for Clinical Research
  • Advanced Research Center
  • The Neurology Center of Southern California - Carlsbad
  • Excell research Inc
  • Anderson Clinical Research
  • University of Colorado Hospital
  • Denver Neurological Clinic - Denver
  • Coastal Connecticut Research LLC
  • Ki Health Partners LLC, dba New England Institute for Clinical Research
  • The George Washington Medical Faculty Associates
  • Medicinae Doctor Clinical
  • AGA Clinical trials
  • Meridien Research - Maitland
  • Palm Beach Neurology and Premiere Research Institute
  • Clinical Research of Central Florida
  • Office of Doctor Frank Berenson
  • iResearch Atlanta, LLC
  • Meridian Clinical Research - Savannah Neurology Specialists
  • Cedar Crosse Research Center
  • College Park Family Care Center Physicians
  • Phoenix Medical Research
  • Central Kentucky Research Associates
  • Boston Clinical Trials
  • MedVadis Research Corporation, LLC
  • Michigan Head Pain and Neurological institute
  • Clinical Research Institute - Minneapolis
  • Headache Neurology Research Institute
  • StudyMetrix Research
  • Clinvest Research
  • Nevada Headache Institute
  • Albuqerque Clinical Trials
  • Dent Neurologic Institute - Amherst
  • Integrative Clinical Trials
  • CTI Clinical Research center
  • Aventiv Research - Columbus
  • Hometown Urgent Care And Research - Huber Heights
  • Neuro-Behavioral Clinical Research Inc
  • Delricht Research
  • Summit Research Network
  • Frontier Clinical Rsearch LLC
  • Coastal Carolina Research Center - Mount Pleasant
  • Chattanooga Medical research LLC
  • WR-ClinSearch LLC
  • Holston Medical Group - Kingsport
  • Ventavia Research Group, LLC
  • Texas Center for Drug Development Inc
  • Ventavia Research Group, LLC
  • J. Lewis Research, Inc. / Foothill Family Clinic
  • Northwest Clinical Research Center
  • Neuroscience Group
  • Ltd "Acad Fridon Todua Medical Center - Ltd Research Institute of Clinical Medicine"
  • Ltd "Aversi Clinic"
  • Ltd "Multiprofile Clinica Consilium Medulla"
  • Ltd Simon Khechinashvili University Clinic
  • td "Israel-Georgia Medical Research Clinic Helsicore"

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Eptinezumab

Placebo

Arm Description

Participants will receive a single dose of eptinezumab 100 milligrams (mg) administered via intravenous (IV) infusion on Day 0.

Participants will receive a single dose of placebo matching to eptinezumab administered via IV infusion on Day 0.

Outcomes

Primary Outcome Measures

Time to Headache Pain Freedom
Time to headache pain freedom defined as the time that the participant reported freedom of pain, meaning their headache pain had gone from moderate to severe at baseline to no pain.
Time to Absence of Most Bothersome Symptom (MBS)
Time to absence of most bothersome symptom defined as the time that the participant reported absence of MBS (of nausea, photophobia, or phonophobia).

Secondary Outcome Measures

Headache Pain Freedom at 2 Hours
Number of participants with freedom from headache pain at 2 hours postdose are reported. Freedom from headache pain meaning that the headache pain that had gone from moderate to severe at baseline to no pain with no administration of rescue medications.
Absence of MBS at 2 Hours
Number of participants with absence of MBS (of nausea, photophobia, or phonophobia) at 2 hours postdose are reported.
Headache Pain Freedom at 4 Hours
Number of participants with freedom from headache pain at 4 hours postdose are reported. Freedom from headache pain meaning that the headache pain that had gone from moderate to severe at baseline to no pain with no administration of rescue medications.
Absence of MBS at 4 Hours
Number of participants with absence of MBS (of nausea, photophobia, or phonophobia) at 4 hours postdose are reported.
Use of Rescue Medication Within the First 24 Hours
Rescue medication was defined as any medication to treat migraine or migraine-associated symptoms, which could have been provided to the participant any time after 2 hours post-start of infusion. Use of rescue medication was captured in the eDiary. Number of participants who used rescue medication up to 24 hours postdose are reported.

Full Information

First Posted
November 2, 2019
Last Updated
August 13, 2021
Sponsor
H. Lundbeck A/S
Collaborators
Alder Biopharmaceuticals, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT04152083
Brief Title
A Study to Evaluate the Efficacy and Safety of Eptinezumab Administered Intravenously in Participants Experiencing Acute Attack of Migraine
Acronym
RELIEF
Official Title
A Parallel Group, Double-Blind, Randomized, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Eptinezumab Administered Intravenously in Subjects Experiencing an Acute Attack of Migraine
Study Type
Interventional

2. Study Status

Record Verification Date
August 2021
Overall Recruitment Status
Completed
Study Start Date
November 7, 2019 (Actual)
Primary Completion Date
July 8, 2020 (Actual)
Study Completion Date
July 8, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
H. Lundbeck A/S
Collaborators
Alder Biopharmaceuticals, Inc.

4. Oversight

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

5. Study Description

Brief Summary
The purpose of this study is to evaluate the efficacy and safety of eptinezumab administered intravenously in participants experiencing an acute attack of migraine.
Detailed Description
This will be a parallel group, double-blind, randomized, placebo-controlled study assessing the efficacy of eptinezumab for acute migraine, defined as an active intercurrent migraine occurring in those participants who are candidates for preventive therapy. Participants will be randomized to receive a single dose of eptinezumab or placebo in a 1:1 ratio. The total study duration will be approximately 4 to 12 weeks, including up to an 8-week screening period and 4-week of safety follow-up, with clinic visits occurring on Screening, Day 0 (dosing day), and Week 4.

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
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
485 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Eptinezumab
Arm Type
Experimental
Arm Description
Participants will receive a single dose of eptinezumab 100 milligrams (mg) administered via intravenous (IV) infusion on Day 0.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Participants will receive a single dose of placebo matching to eptinezumab administered via IV infusion on Day 0.
Intervention Type
Drug
Intervention Name(s)
Eptinezumab
Intervention Description
Injection for IV administration
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Injection for IV administration
Primary Outcome Measure Information:
Title
Time to Headache Pain Freedom
Description
Time to headache pain freedom defined as the time that the participant reported freedom of pain, meaning their headache pain had gone from moderate to severe at baseline to no pain.
Time Frame
Up to 48 hours postdose
Title
Time to Absence of Most Bothersome Symptom (MBS)
Description
Time to absence of most bothersome symptom defined as the time that the participant reported absence of MBS (of nausea, photophobia, or phonophobia).
Time Frame
Up to 48 hours postdose
Secondary Outcome Measure Information:
Title
Headache Pain Freedom at 2 Hours
Description
Number of participants with freedom from headache pain at 2 hours postdose are reported. Freedom from headache pain meaning that the headache pain that had gone from moderate to severe at baseline to no pain with no administration of rescue medications.
Time Frame
2 hours
Title
Absence of MBS at 2 Hours
Description
Number of participants with absence of MBS (of nausea, photophobia, or phonophobia) at 2 hours postdose are reported.
Time Frame
2 hours
Title
Headache Pain Freedom at 4 Hours
Description
Number of participants with freedom from headache pain at 4 hours postdose are reported. Freedom from headache pain meaning that the headache pain that had gone from moderate to severe at baseline to no pain with no administration of rescue medications.
Time Frame
4 hours
Title
Absence of MBS at 4 Hours
Description
Number of participants with absence of MBS (of nausea, photophobia, or phonophobia) at 4 hours postdose are reported.
Time Frame
4 hours
Title
Use of Rescue Medication Within the First 24 Hours
Description
Rescue medication was defined as any medication to treat migraine or migraine-associated symptoms, which could have been provided to the participant any time after 2 hours post-start of infusion. Use of rescue medication was captured in the eDiary. Number of participants who used rescue medication up to 24 hours postdose are reported.
Time Frame
Up to 24 hours postdose

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: Greater than 1-year history of migraine, with or without aura, with onset of first migraine before age 50. Migraine on 4 to 15 days per month in the 3 months prior to screening. Headache free for at least 24 hours prior to onset of a qualifying migraine. Exclusion Criteria: Unable to differentiate migraine from other headache or pain disorders. Use of the following medication, for any indication, within the 24-hour period prior to dosing with study drug: triptans, ergotamines and ergot-derivatives analgesics (including but not limited to acetaminophen, tramadol, nonsteroidal anti-inflammatory drugs [NSAIDs], combination analgesics, caffeine-containing analgesics, and opioids/narcotics) and other acute migraine medication(s) antiemetic medications (including but not limited to prochlorperazine, promethazine, droperidol, chlorpromazine, metoclopramide) antihistamines devices, neuromodulation, neurostimulation, or injectable therapy (trigger point injections, extracranial nerve blocks, facet joint injections, spinal manipulation) Use of the following medication, for any indication, in each of the 3 months prior to screening: opioids/narcotics or butalbital containing products (including combinations) on more than 4 days per month; triptans, ergotamines, or combination analgesics for 10 or more days per month; acetaminophen, aspirin or NSAIDs for 15 or more days per month (except if participant is taking 81 mg dose of aspirin for cardiac prophylaxis) History or diagnosis of chronic tension-type headache, hypnic headache, cluster headache, hemicrania continua, new daily persistent headache, or unusual migraine subtypes such as hemiplegic migraine (sporadic and familial), ophthalmoplegic migraine and migraine with neurological accompaniments that are not typical of migraine aura (for example, diplopia, altered consciousness, or long duration). Any changes to preventive migraine treatment(s) within 1 month prior to screening and up to treatment with the study drug (Day 0). Any use of approved devices, neuromodulation, neurostimulation, or injectable therapy (trigger point injections, extracranial nerve blocks, facet joint injections) within the 24-hour period prior to treatment with study drug (Day 0). Any use of botulinum toxin for migraine or for any other medical/cosmetic reasons requiring injections within 7 days prior to treatment with study drug (Day 0). Any use of systemic corticosteroid for migraine or any other reason within 3 months prior to treatment with study drug (Day 0). Evidence or medical history of clinically significant psychiatric diseases that are uncontrolled and/or untreated. Receipt of any monoclonal antibody treatment, for migraine or any other indication, (within or outside a clinical study) within 6 months prior to screening.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Email contact via H. Lundbeck A/S
Organizational Affiliation
LundbeckClinicalTrials@lundbeck.com
Official's Role
Study Director
Facility Information:
Facility Name
Alabama Clinical Therapeutics
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35235
Country
United States
Facility Name
Arizona Research Center
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85053
Country
United States
Facility Name
Baptist Health Center for Clinical Research
City
Little Rock
State/Province
Arkansas
ZIP/Postal Code
72205
Country
United States
Facility Name
Advanced Research Center
City
Anaheim
State/Province
California
ZIP/Postal Code
92805
Country
United States
Facility Name
The Neurology Center of Southern California - Carlsbad
City
Carlsbad
State/Province
California
ZIP/Postal Code
92011
Country
United States
Facility Name
Excell research Inc
City
Oceanside
State/Province
California
ZIP/Postal Code
92056
Country
United States
Facility Name
Anderson Clinical Research
City
Redlands
State/Province
California
ZIP/Postal Code
92374
Country
United States
Facility Name
University of Colorado Hospital
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
Denver Neurological Clinic - Denver
City
Denver
State/Province
Colorado
ZIP/Postal Code
80210
Country
United States
Facility Name
Coastal Connecticut Research LLC
City
New London
State/Province
Connecticut
ZIP/Postal Code
06320
Country
United States
Facility Name
Ki Health Partners LLC, dba New England Institute for Clinical Research
City
Stamford
State/Province
Connecticut
ZIP/Postal Code
06905
Country
United States
Facility Name
The George Washington Medical Faculty Associates
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20052
Country
United States
Facility Name
Medicinae Doctor Clinical
City
Hallandale Beach
State/Province
Florida
ZIP/Postal Code
33009
Country
United States
Facility Name
AGA Clinical trials
City
Hialeah
State/Province
Florida
ZIP/Postal Code
33012
Country
United States
Facility Name
Meridien Research - Maitland
City
Maitland
State/Province
Florida
ZIP/Postal Code
32751
Country
United States
Facility Name
Palm Beach Neurology and Premiere Research Institute
City
West Palm Beach
State/Province
Florida
ZIP/Postal Code
33407
Country
United States
Facility Name
Clinical Research of Central Florida
City
Winter Haven
State/Province
Florida
ZIP/Postal Code
33880
Country
United States
Facility Name
Office of Doctor Frank Berenson
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30328
Country
United States
Facility Name
iResearch Atlanta, LLC
City
Decatur
State/Province
Georgia
ZIP/Postal Code
30030
Country
United States
Facility Name
Meridian Clinical Research - Savannah Neurology Specialists
City
Savannah
State/Province
Georgia
ZIP/Postal Code
31405
Country
United States
Facility Name
Cedar Crosse Research Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60607
Country
United States
Facility Name
College Park Family Care Center Physicians
City
Overland Park
State/Province
Kansas
ZIP/Postal Code
66212
Country
United States
Facility Name
Phoenix Medical Research
City
Prairie Village
State/Province
Kansas
ZIP/Postal Code
66208
Country
United States
Facility Name
Central Kentucky Research Associates
City
Lexington
State/Province
Kentucky
ZIP/Postal Code
40509
Country
United States
Facility Name
Boston Clinical Trials
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02131
Country
United States
Facility Name
MedVadis Research Corporation, LLC
City
Waltham
State/Province
Massachusetts
ZIP/Postal Code
02451
Country
United States
Facility Name
Michigan Head Pain and Neurological institute
City
Ann Arbor
State/Province
Michigan
ZIP/Postal Code
48104
Country
United States
Facility Name
Clinical Research Institute - Minneapolis
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55402
Country
United States
Facility Name
Headache Neurology Research Institute
City
Ridgeland
State/Province
Mississippi
ZIP/Postal Code
39157
Country
United States
Facility Name
StudyMetrix Research
City
Saint Peters
State/Province
Missouri
ZIP/Postal Code
63303
Country
United States
Facility Name
Clinvest Research
City
Springfield
State/Province
Missouri
ZIP/Postal Code
65810
Country
United States
Facility Name
Nevada Headache Institute
City
Las Vegas
State/Province
Nevada
ZIP/Postal Code
89113
Country
United States
Facility Name
Albuqerque Clinical Trials
City
Albuquerque
State/Province
New Mexico
ZIP/Postal Code
87102
Country
United States
Facility Name
Dent Neurologic Institute - Amherst
City
Amherst
State/Province
New York
ZIP/Postal Code
14226
Country
United States
Facility Name
Integrative Clinical Trials
City
Brooklyn
State/Province
New York
ZIP/Postal Code
11229
Country
United States
Facility Name
CTI Clinical Research center
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45212
Country
United States
Facility Name
Aventiv Research - Columbus
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43213
Country
United States
Facility Name
Hometown Urgent Care And Research - Huber Heights
City
Dayton
State/Province
Ohio
ZIP/Postal Code
45424
Country
United States
Facility Name
Neuro-Behavioral Clinical Research Inc
City
North Canton
State/Province
Ohio
ZIP/Postal Code
44720
Country
United States
Facility Name
Delricht Research
City
Tulsa
State/Province
Oklahoma
ZIP/Postal Code
74133
Country
United States
Facility Name
Summit Research Network
City
Portland
State/Province
Oregon
ZIP/Postal Code
97210
Country
United States
Facility Name
Frontier Clinical Rsearch LLC
City
Smithfield
State/Province
Pennsylvania
ZIP/Postal Code
15478
Country
United States
Facility Name
Coastal Carolina Research Center - Mount Pleasant
City
Mount Pleasant
State/Province
South Carolina
ZIP/Postal Code
29464
Country
United States
Facility Name
Chattanooga Medical research LLC
City
Chattanooga
State/Province
Tennessee
ZIP/Postal Code
37404
Country
United States
Facility Name
WR-ClinSearch LLC
City
Chattanooga
State/Province
Tennessee
ZIP/Postal Code
37421
Country
United States
Facility Name
Holston Medical Group - Kingsport
City
Kingsport
State/Province
Tennessee
ZIP/Postal Code
37660
Country
United States
Facility Name
Ventavia Research Group, LLC
City
Fort Worth
State/Province
Texas
ZIP/Postal Code
76104
Country
United States
Facility Name
Texas Center for Drug Development Inc
City
Houston
State/Province
Texas
ZIP/Postal Code
77081
Country
United States
Facility Name
Ventavia Research Group, LLC
City
Keller
State/Province
Texas
ZIP/Postal Code
76248
Country
United States
Facility Name
J. Lewis Research, Inc. / Foothill Family Clinic
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84109
Country
United States
Facility Name
Northwest Clinical Research Center
City
Bellevue
State/Province
Washington
ZIP/Postal Code
98007
Country
United States
Facility Name
Neuroscience Group
City
Neenah
State/Province
Wisconsin
ZIP/Postal Code
54956
Country
United States
Facility Name
Ltd "Acad Fridon Todua Medical Center - Ltd Research Institute of Clinical Medicine"
City
Tbilisi
Country
Georgia
Facility Name
Ltd "Aversi Clinic"
City
Tbilisi
Country
Georgia
Facility Name
Ltd "Multiprofile Clinica Consilium Medulla"
City
Tbilisi
Country
Georgia
Facility Name
Ltd Simon Khechinashvili University Clinic
City
Tbilisi
Country
Georgia
Facility Name
td "Israel-Georgia Medical Research Clinic Helsicore"
City
Tbilisi
Country
Georgia

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
35902796
Citation
Cady R, Lipton RB, Buse DC, Josiassen MK, Lindsten A, Ettrup A. Optimization of acute medication use following eptinezumab initiation during a migraine attack: post hoc analysis of the RELIEF study. J Headache Pain. 2022 Jul 28;23(1):91. doi: 10.1186/s10194-022-01463-3.
Results Reference
derived
PubMed Identifier
35659622
Citation
Ailani J, McAllister P, Winner PK, Chakhava G, Krog Josiassen M, Lindsten A, Sperling B, Ettrup A, Cady R. Rapid resolution of migraine symptoms after initiating the preventive treatment eptinezumab during a migraine attack: results from the randomized RELIEF trial. BMC Neurol. 2022 Jun 3;22(1):205. doi: 10.1186/s12883-022-02714-1. Erratum In: BMC Neurol. 2023 Sep 6;23(1):318.
Results Reference
derived
PubMed Identifier
35130832
Citation
McAllister P, Winner PK, Ailani J, Buse DC, Lipton RB, Chakhava G, Josiassen MK, Lindsten A, Mehta L, Ettrup A, Cady R. Eptinezumab treatment initiated during a migraine attack is associated with meaningful improvement in patient-reported outcome measures: secondary results from the randomized controlled RELIEF study. J Headache Pain. 2022 Feb 7;23(1):22. doi: 10.1186/s10194-021-01376-7.
Results Reference
derived
PubMed Identifier
34128999
Citation
Winner PK, McAllister P, Chakhava G, Ailani J, Ettrup A, Krog Josiassen M, Lindsten A, Mehta L, Cady R. Effects of Intravenous Eptinezumab vs Placebo on Headache Pain and Most Bothersome Symptom When Initiated During a Migraine Attack: A Randomized Clinical Trial. JAMA. 2021 Jun 15;325(23):2348-2356. doi: 10.1001/jama.2021.7665.
Results Reference
derived

Learn more about this trial

A Study to Evaluate the Efficacy and Safety of Eptinezumab Administered Intravenously in Participants Experiencing Acute Attack of Migraine

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