Evaluation of a Novel Device for Treatment of Migraine Headache
Keywords
Abstract
Description
Nerivio Migra is intended for the acute treatment of migraine with or without aura in patients 18 years of age or older. It is self-applied to the upper arm. Treatments are self-administered by the user at the onset of a migraine attack. The device delivers extra cephalic transcutaneous electrical stimulation below the pain threshold to the skin of the upper arm at the onset of a migraine attack. Nerivio Migra is operated via a mobile application.
This is a prospective, randomized, double-blind, sham controlled multi-center clinical trial to test the ability of the Nerivio Migra neuromodulation device to relieve the patient's migraine pain during a migraine attack. The study will enroll up to 270 patients diagnosed with migraine with or without aura, per the inclusion and exclusion criteria. These patients will be individually and randomly assigned to either treatment group or control group. For sham control, electrical pulses of similar width and intensity, but much lower frequency compared to the active device will be administered. This sham program produces pulses that are perceivable by the user, thus maintaining the blinding, but on the other hand do not have therapeutic qualities, based on existing knowledge of parameters range of electro stimulation treatments.
1. st visit - screening, enrollment and training on the application in diary mode Following successful screening, enrollment interview and signing of informed consent, participants will be provided with the Nerivio Migra application (either installed on their own smartphone, or on a smartphone provided by the study coordinator). The participants will be trained how to operate the application and report their migraine attacks in the patient diary mode, which is part of the application. The site personnel will be required to approve the training session in the CRF.
Stage 1 - Roll in phase The Roll-in is a period of 15 - 30 days in which at least two (2) and no more of eight (8) migraine attacks has been occurred. During this period, baseline information including mean frequency and severity of migraine attacks, occurrence of other headaches, presence of ICHD-3 diagnostic criteria for migraine with or without aura and use of preventive and rescue medications will be recorded.
2. nd visit Following the Roll-in phase, the participants will arrive to the clinic and their compliance to the study procedures and eligibility to continue to the next phase will assessed.
Participants that will be eligible to continue to the treatment phase will undergo the following:
1. Participant will be randomized into one of the two study group (Active or Sham device) Investigational devices will be programmed in active or sham mode with a 1:1 ratio, in order to achieve the desired ratio between active and control groups sizes, stratified with by use of preventive medications.
2. Participant will be trained on the device, the application (in diary and treatment modes), the treatment procedures and the key elements critical for the success of the study:
- Apply the Nerivio Migra as soon as possible following the onset of the migraine symptoms and NO LATER than 60 min from onset
- Refrain from taking any rescue medication 2 hours following the start of treatment.
- Perform the treatment for a period of at least 30 minutes (recommended treatment time is 45 minutes).
Stage 2 - Parallel arms, double- blind treatment phase. Participants will be instructed to activate the device at onset of a qualifying migraine attack and manually adjust stimulation intensity to a level within the pre-defined range, where it is well perceived but not painful. A qualifying migraine attack shall be preceded by at least 48 hours of freedom from migraine. Patients will be requested to refrain from use of rescue medications prior to and during the first two hours after treatment with the device, and if they cannot comply with this, record their use of rescue medications (migraine specific drugs or other medications or therapies that may be used to treat pain, from a pre-specified list) in the mobile application.
Via the smartphone application, each participant will be asked to rate his/her migraine pain level three times using Pain Grades Scale (0 - no pain, 1- mild pain, 2- moderate pain, 3 - severe pain): (1) upon starting the treatment, (2) two hours after start of treatment, (3) 48 hours after start of attack. At the start of each treatment, participants will be also asked to provide time elapsed from start of migraine symptoms to start of the treatment. Participants will be also asked to provide feedback regarding their use of medication (migraine specific drugs or other medications or therapies that may be used to treat pain, from a pre-specified list), presence of nausea, photophobia, phonophobia or allodynia, and treatment perception. After providing feedback at two hours after start of treatment and in case of pain recurrence, participants will be allowed to re-treat the attack using Nerivio Migra device.
Adverse events will be reported.
Stage 3 (optional, by subject request only) - Open label extended treatment:
Following the completion of double-blind stage of the study, all subjects will be offered a 2-month open label period using the active device.
Dates
| Last Verified: | 01/31/2019 |
| First Submitted: | 11/17/2017 |
| Estimated Enrollment Submitted: | 11/30/2017 |
| First Posted: | 12/03/2017 |
| Last Update Submitted: | 02/13/2019 |
| Last Update Posted: | 02/14/2019 |
| Actual Study Start Date: | 12/16/2017 |
| Estimated Primary Completion Date: | 11/24/2018 |
| Estimated Study Completion Date: | 12/24/2018 |
Condition or disease
Intervention/treatment
Device: treatment of migraine with active device
Device: treatment of migraine with sham device
Phase
Arm Groups
| Arm | Intervention/treatment |
|---|---|
| Active Comparator: treatment of migraine with active device Treatment of acute migraine with an active form of Nerivio migra-1 device | Device: treatment of migraine with active device The device is placed on the subject upper arm. when activated, stimulus is applied to influence the subject's perception of a painful stimulus, delivered (or originating) at a different location. Based on diffused noxious inhibitory control mechanism, sometimes referred to as "pain inhibits pain" principle, conditioned pain modulation evokes an endogenous analgesic mechanism. The modulatory effect is over the whole body, and can be induced anywhere in the body. This approach allows applying the conditioning stimuli away from the painful site. |
| Sham Comparator: treatment of migraine with sham device Treatment of acute migraine with a sham form of the Nerivio Migra-1 device | Device: treatment of migraine with sham device The device is placed on the subject upper arm. when activated, the stimulus is applied is not sufficient to influence the subject's perception of a painful stimulus. |
Eligibility Criteria
| Ages Eligible for Study | 18 Years To 18 Years |
| Sexes Eligible for Study | All |
| Accepts Healthy Volunteers | Yes |
| Criteria | Inclusion Criteria: 1. Subjects age 18-75 years old. 2. Subjects meet the ICHD-3 diagnostic criteria for migraine with or without aura 3. Subjects report 2-8 migraine attacks per month. 4. Stable migraine preventive medications in the last two months prior to recruitment (No change in usage or dosage). 5. Subjects must be able and willing to comply with the protocol 6. Subjects must be able and willing to provide written informed consent Exclusion Criteria: 1. Subject has other significant pain, medical or psychologic problems that in the opinion of the investigator may confound the study assessments 2. Subject has an implanted electrical and/or neurostimulator device (e.g. cardiac pacemaker or defibrillator, vagus nerve neurostimulator, deep brain stimulator, spinal stimulator, bone growth stimulator cochlear implant, Sphenopalatine ganglion stimulator or Occipital nerve stimulator). 3. Subject has known uncontrolled epilepsy. 4. Any use of Cannabis including medical use. 5. Subject has >10 headache days per month. 6. Subject has undergone nerve block (occipital or other) in the head or neck within the last 2 weeks. 7. Subject is participating in any other clinical study. 8. The subject does not have the basic cognitive and motor skills needed to operate a smartphone. 9. Pregnant, or trying to get pregnant 10. Subject is experiencing a menstrually related migraine 11. Received OnabotulinumtoxinA or any botulinum toxin injections for migraine within the previous month 12. Received parenteral infusions for migraine within the previous 2 weeks. 13. Subject participated in a previous study with the Nerivio Migra 1 device |
Outcome
Primary Outcome Measures
1. Percentage of reduction of migraine headache post 2 hours from treatment [2 hours post migraine onset]
Secondary Outcome Measures
1. Percentage of reduction of most bothersome migraine-associated symptom (MBS) relief post 2 hours treatment [2 hours post migraine onset]
2. Percentage of reduced Migraine Headache AND MBS Relief post 2 hours post tresatment [2 hours post migraine onset]
3. Percentage of pain disappearance 2 hours post treatment [2 hours post migraine onset]
Other Outcome Measures
1. Safety performance of the study device following treatment with study device: Rate of Adverse events related or unrelated to the study device [48 hours post migraine onset]
