Anthony Fiorino, MD, PhD: Using nVNS in Various Migraine Populations

“The use [of nVNS] in patients with aura is interesting because we have a mechanistic tie-in and we have a case report—and we’ll hopefully soon have others—where the device is active on aura, as opposed to the migraine headache itself…and in the prior clinical studies, we have seen that aura patients seem to respond particularly well.”

At the 2019 American Headache Society Annual Meeting, July 11-14, in Philadelphia, Pennsylvania, one of the topics of focus among the newly approved therapies for migraine was the use of devices to treat the condition acutely. As such, a number of companies presented data on neuromodulation and neurostimulation devices—including electroCore, which has undergone the development of noninvasive vagus nerve stimulation (nVNS) to treat migraine, episodic cluster headache, and is currently being studied in post-traumatic headache.^1-3

With a number of oral presentations from scientific collaborators, the data explored much of the mechanism of action for nVNS in order to uncover how the stimulation device can inhibit cortical spreading depression and trigeminal nociception. Additionally, there were data presented from the PREMIUM trial, a multicenter, double-blind, randomized, sham-controlled trial in episodic migraine.

To find out more about both the mechanistic and clinical data presented by electroCore on its nVNS system, NeurologyLive^® sat with Anthony Fiorino, MD, PhD, chief medical officer, electroCore. Fiorino discussed a number of details regarding the understanding of the mechanistic workings of nVNS, as well as shared some insight into the data he found to be most interesting: the use of nVNS in migraine with aura.

For more coverage of AHS 2019, click here.

REFERENCES

1. Lopes de Morias A. Central Mechanisms of Cortical Spreading Depression Inhibition by Vagus Nerve Stimulation. Presented at: 2019 American Headache Society Annual Meeting. July 11-14, 2019; Philadelphia, PA. Session DB02.

2. Durham P. Noninvasive Vagus Nerve Stimulation and Morphine Transiently Inhibit Trigeminal Pain Signaling in a Chronic Migraine Model. Presented at: 2019 American Headache Society Annual Meeting. July 11-14, 2019; Philadelphia, PA. Session DB11.

3. Durham P. Noninvasive Vagus Nerve Stimulation Inhibits Trigeminal Nociception in Two Episodic Migraine Models by Enhancing Descending Pain Modulation. Presented at: 2019 American Headache Society Annual Meeting. July 11-14, 2019; Philadelphia, PA. Session OR07.