Vagus Nerve Stimulation Improves Headache, Migraine Pain

Cristina Tassorelli, MD, PhD, Director of the Headache Science Centre, National Neurological Institute C. Mondino Foundation, Professor at the University of Pavia, Pavia, Italy

Cristina Tassorelli, MD, PhD

The hand-held gammaCore device, which is a non-invasive vagus nerve stimulation (nVNS) therapy, significantly improved pain-free rates compared with a sham device for patients with episodic cluster headache and migraines, according to findings from the PRESTO trial presented at the American Academy of Neurology (AAN) annual meeting.

PRESTO found that treatment with gammaCore led to significantly higher pain-free rates in treated patients versus the sham patient population at both the 30-minute mark for migraine treatment (12.7% versus 4.2%; P = .012) and the 60-minute mark (21.0% versus 10.0%; P = 0.023). However, the study missed its primary endpoint of improvement in pain at 120 minutes.

“Migraine is the third most common disease in the world, and one of the 10 most disabling diseases, which highlights a need for novel treatment options,” principal trial investigator Cristina Tassorelli, MD, PhD, Director of the Headache Science Centre, National Neurological Institute C. Mondino Foundation, Professor at the University of Pavia, Pavia, Italy, said in a statement.

The multicenter, double-blind, randomized trial evaluated the efficacy, safety, and tolerability of nVNS in 243 patients with episodic migraine. The study consisted of 3 timeframes, a baseline period where participants used standard of care treatments, a 4-week randomized, controlled, and double-blind period, and a subsequent 4-week open-label period where all participants used the gammaCore device.

The device missed clinical and statistical significance for the study’s primary endpoint, reduction of pain at 120 minutes (nVNS 30.4% versus sham 19.7%; P = .067). However, a post-hoc repeated-measures test suggested that nVNS treatment was superior to sham at 120 minutes (odds ratio: 2.3; 95% CI: 1.2, 4.4; P = .012).

“The PRESTO data suggests that gammaCore was rapidly effective, well tolerated and practical for the acute treatment of episodic migraine. The data supports the use of gammaCore to successfully treat a migraine, making the device a potentially valuable treatment for the millions of people who suffer from migraine,” said Tassorelli.

Secondary endpoints for the study showed clinically meaningful and statistically significant results. These endpoints included mild or no pain at 120 minutes (nVNS 40.8% vs sham 27.6%; P = .030) and mean percent pain reduction at 120 minutes (nVNS 34.8% vs sham 5.4%; P = .004).

“Migraine is a debilitating disease affecting 39 million Americans, the majority of whom do not seek medical care for their pain,” said Stephen D. Silberstein, MD, Professor of Neurology and Director of the Headache Center, Thomas Jefferson University. “With the FDA’s decision to release gammaCore for migraine, patients now have access to an effective and safe therapy which can be self-administered to acutely treat the pain associated with migraine.”

The device is already available for the acute treatment of pain due to episodic cluster headache in adults, and electroCore, the company developing the device, expects commercial availability of gammaCore for the acute treatment of pain associated with migraine headache in adults in the second quarter of 2018.