Efficacy and Safety of Nerivio™ for Acute Treatment of Migraine in People With Chronic Migraine

Efficacy and Safety of Nerivio™, a Remote Electrical Neuromodulation Device, for Acute Treatment of Migraine in People With Chronic Migraine: an Open Label, Single Arm, Multicenter Study

This study is intended to evaluate the efficacy and safety of Nerivio, an FDA-authorized remote electrical neuromodulation (REN) device for the acute treatment of migraine, for the acute treatment of migraine in people with chronic migraine. The device delivers transcutaneous electrical stimulation to the upper arm to induce conditioned pain modulation (CPM) that activates a descending endogenous analgesic mechanism. The study duration consists of a 4 weeks of active treatment with the device in about 40 patients.

This open label study includes up to 2 visits. The enrollment and device training may occur in 2 separate visits. First visit - The first visit will include screening, enrollment and training on the application and device. Treatment phase - Participants will be instructed to use the device for the treatment of qualifying migraine headaches (see below) as soon as possible and always within 60 minutes of onset during a period of up to 4 weeks. Participants will be instructed to use the device with the intensity level identified during the device training visit (and adjust as necessary) and make sure the stimulation is perceptible but not painful. Participants will be instructed to avoid taking rescue medications within 2 hours post-treatment. If medications are used, participants will be instructed to record in the app when and which medication was taken at 2- and 24-hours post treatment. The participants will use the app to record pain intensity levels, the presence/absence of aura and associated migraine symptoms (nausea, photophobia, phonophobia, and allodynia l) as well as rate their stress level and functional disability at baseline, 2- and 24-hours post-treatment. At the beginning of each treatment, participants will also be asked to report the time elapsed from attack onset. Adverse events will be reported throughout this phase of the study directly to the site staff. Participants who do not achieve satisfactory relief at 2 hours post-treatment may treat again with the Nerivio™ device or may treat with usual care at that time or any time thereafter if the headache does not resolve. Participants will also be able to treat headache recurrence with the device. Migraine headaches that are not treated with the device may be treated with usual care. The first reported treatment will be considered a "training" treatment, aimed to verify that the participants use the device properly, and will only be included in the safety analysis. The efficacy evaluation will be performed on the first treatment of a qualifying attack (see below) following the training treatment (hereby termed "test treatment"). Second (final) visit - End of study: Participants will return to the clinic following the end of the treatment phase, at which time they will return the device. The participants will have the option of returning the device by mail instead of an on-site visit.

participant will receive the Nerivio device for treating their migraine attacks. Treatment will be perform as soon as the participant feel that the migraine attack started

The device delivers transcutaneous electrical stimulation to the upper arm to induce conditioned pain modulation (CPM) that activates a descending endogenous analgesic mechanism. The treatment is self-administered and controlled by a smartphone application.

The proportion of participants reporting pain relief at 2 hours post-treatment without the use of rescue medication following the test treatment . Pain relief is defined as an improvement from severe or moderate pain to mild or no pain, or from mild pain to no pain.

The proportion of participants reporting freedom from migraine pain at 2 hours post-treatment without medications following the test treatment. Pain freedom is defined as an improvement from severe or moderate or mild pain to no pain

The proportion of participants reporting disappearance of nausea and/or vomiting at 2 hours post-treatment without rescue medications following the test treatment.

The proportion of participants reporting disappearance of photophobia at 2 hours post-treatment without rescue medications following the test treatment.

The proportion of participants reporting disappearance phonophobia at 2 hours post-treatment without rescue medications following the test treatment.

Within-patient Consistency - Percentage of Participants With Reduction in Headache Pain in at Least 50% of Their Treatments

Proportions of participants achieving pain relief at 2 hours in at least 50% of all their treatments (excluding the training treatment)

Within-patient Consistency - Percentage of Participants Free of Headache Pain in at Least 50% of Their Treatments

Proportion of participants achieving pain free at 2 hours in at least 50% of all their treatments (excluding the training treatment)

The proportion of participants achieving improvement of at least one grade in functional disability in the test treatment at 2 hours post-treatment with no use of rescue medication. the scale used was: (0) No limitation, (1) Some limitation, (2) Moderate limitation and (3) Severe limitation.

The proportion of participants achieving improvement of at least one grade in functional disability in the test treatment at 24 hours post-treatment with no use of rescue medication. the scale used was: (0) No limitation, (1) Some limitation, (2) Moderate limitation and (3) Severe limitation.

Inclusion Criteria: Participants aged 18-75 years old. Participants meeting the ICHD-3 diagnostic criteria for chronic migraine Participants have personal access to a smartphone Participants must be able and willing to comply with the protocol Participants must be able and willing to provide written informed consent Exclusion Criteria: Participants with an implanted electrical and/or neurostimulator device (e.g. cardiac pacemaker, cochlear implant). Participants with congestive heart failure (CHF), severe cardiac or cerebrovascular disease. Participants with uncontrolled epilepsy. Lack of efficacy, after an adequate therapeutic trial, of at least two migraine specific acute medications Change in migraine preventive medications (type or dose) in the last two months prior to recruitment and/or during the study Pregnant, trying to get pregnant or breastfeeding female participants Subjects participating in any other interventional clinical study. Participants without basic cognitive and motor skills needed to operate a smartphone Participants with other significant pain, medical or psychological problems that in the opinion of the investigator may confound the study assessments Participants who have previous experience with the device

Nierenburg H, Vieira JR, Lev N, Lin T, Harris D, Vizel M, Ironi A, Lewis B, Wright P. Remote Electrical Neuromodulation for the Acute Treatment of Migraine in Patients with Chronic Migraine: An Open-Label Pilot Study. Pain Ther. 2020 Dec;9(2):531-543. doi: 10.1007/s40122-020-00185-1. Epub 2020 Jul 9.