Clinical trial NCT04461795
Conditions: Migraine
Sponsor: David True
Start date: 2020-12-01; Completion date: 2022-01-10
Enrollment: 40 participants; Allocation: NA; Intervention model: SINGLE_GROUP

Brief summary:
This study is being conducted to evaluate the efficacy and safety of AJOVY (fremanezumab-vfrm) on interictal migraine related burden in adults.

Detailed description:
This is a single group, multicenter, open-label study with a study population of patients who meet International Classification of Headache Disorders 3rd edition (ICHD-III) criteria for migraine with or without aura and have 4 to 22 migraine days per month. This is a single-group supportive care study with one arm and no masking. A maximum of 40 participants will be enrolled to study intervention. All participants in this single-group study will complete a 4-week run-in period. After the run-in period, eligible participants will be enrolled to study intervention and enter a 12-week treatment period.

Arms: arm 1: Participants received 225 mg/1.5 mL solution via single-dose prefilled syringe administered subcutaneously once every 4 weeks in the abdomen, thigh, or upper arm for 12 weeks.
Interventions: intervention 1: Fremanezumab-Vfrm 225 MG/1.5 ML Subcutaneous Solution [AJOVY]
Intervention descriptions: intervention 1: 225 MG/1.5 ML Subcutaneous Solution

Protocol documents:
Prot_SAP_000.pdf: 
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Title Page 
Protocol Title: A Multicenter, Open Label Study Assessing the Efficacy of AJOVY® 
(fremanezumab-vfrm) on Interictal Migraine Related Burden 
Protocol Number: 19-001TE 
Amendment Number: NA 
Investigational Product: 225 mg fremanezumab-vfrm 
Study Phase: Phase 4 
Sponsor Name: David True, DO 
Legal Registered Address:  Clinvest Research 
4350 South National 
Suite C100 
Springfield MO, 65810 
Approval Date: 05-Oct-2020 
 
 


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Page 2 of 50 
 
Sponsor Signatory: 
 
 
 
 
 
David True, DO  
Medical Monitor Clinvest Research 
 
Date 
 
 
 
 
 
 
 
 
 
Principal Investigator Signatory: 
 
 
 
 
 
Investigative Site Principal Investigator  
 
 
Date 
 
 
 


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Table of Contents 
1. 
Protocol Summary ..........................................................................................................6 
1.1. 
Synopsis ............................................................................................................................6 
1.2. 
Schedule of Activities (SoA) ............................................................................................9 
2. 
Introduction ...................................................................................................................11 
2.1. 
Study Rationale ...............................................................................................................11 
2.2. 
Background .....................................................................................................................11 
2.3. 
Significance ....................................................................................................................11 
2.4. 
Benefit/Risk Assessment ................................................................................................12 
3. 
Objectives and Endpoints ............................................................................................13 
4. 
Study Design ..................................................................................................................15 
4.1. 
Overall Design ................................................................................................................15 
4.2. 
End of Study Definition ..................................................................................................16 
5. 
Study Population ...........................................................................................................17 
5.1. 
Inclusion Criteria ............................................................................................................17 
5.2. 
Exclusion Criteria ...........................................................................................................18 
5.3. 
Screen Failures ................................................................................................................19 
6. 
Study Intervention ........................................................................................................20 
6.1. 
Study Intervention(s) Administered ................................................................................20 
6.2. 
Preparation/Handling/Storage/Accountability ................................................................20 
6.3. 
Measures to Minimize Bias: Randomization and Blinding ............................................20 
6.4. 
Study Intervention Compliance ......................................................................................21 
6.5. 
Concomitant Therapy .....................................................................................................21 
6.5.1. 
Prohibited Medications ...................................................................................................21 
7. 
Discontinuation of Study Intervention and Participant 
Discontinuation/Withdrawal........................................................................................22 
7.1. 
Discontinuation of Study Intervention ............................................................................22 
7.2. 
Participant Discontinuation/Withdrawal from the Study ................................................22 
7.3. 
Lost to Follow up ............................................................................................................22 
8. 
Study Assessments and Procedures.............................................................................24 
8.1. 
Efficacy Assessments .....................................................................................................24 
8.1.1. 
Migraine Interictal Burden Scale (MIBS-4) ...................................................................24 
Participants will complete an electronic version of the MIBS-4 within the 
clinic during visits outlined in the SoA. ..........................................................................24 
8.1.2. 
Migraine Days via Daily Headache Diary (DHD) ..........................................................24 
8.1.3. 
Neuro-QoL Sleep Disturbance Short Form (SDSF) .......................................................24 
8.1.4. 
General Self-Efficacy Short Form (GSE-SF) .................................................................25 
8.1.5. 
PROMIS-29 ....................................................................................................................25 


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8.1.6. 
Work Productivity and Activity Impairment- Migraine (WPAI-
M) ....................................................................................................................................25 
8.1.7. 
Brief Measure of Worry Severity (BMWS) ....................................................................25 
8.1.8. 
Activity and Sleep via wearable device ..........................................................................25 
8.2. 
Safety Assessments .........................................................................................................25 
8.2.1. 
Physical and Neurological Examinations .......................................................................25 
8.2.2. 
Vital Signs .......................................................................................................................25 
8.2.3. 
Electrocardiograms .........................................................................................................26 
8.2.4. 
Clinical Safety Laboratory Assessments ........................................................................26 
8.2.5. 
Suicidal Ideation and Behavior Risk Monitoring ...........................................................27 
8.3. 
Adverse Events and Serious Adverse Events .................................................................27 
8.3.1. 
Time Period and Frequency for Collecting AE and SAE 
Information .....................................................................................................................27 
8.3.2. 
Method of Detecting AEs and SAEs ..............................................................................28 
8.3.3. 
Follow-up of AEs and SAEs ...........................................................................................28 
8.3.4. 
Regulatory Reporting Requirements for SAEs ...............................................................28 
8.3.5. 
Pregnancy ........................................................................................................................28 
8.4. 
Treatment of Overdose ...................................................................................................29 
8.5. 
Pharmacokinetics ............................................................................................................29 
8.6. 
Genetics ..........................................................................................................................29 
8.7. 
Biomarkers ......................................................................................................................29 
8.8. 
Immunogenicity Assessments.........................................................................................29 
8.9. 
Medical Resource Utilization and Health Economics ....................................................29 
9. 
Statistical Considerations .............................................................................................30 
9.1. 
Statistical Hypotheses .....................................................................................................30 
9.2. 
Sample Size Determination ............................................................................................30 
9.3. 
Populations for Analyses ................................................................................................30 
9.4. 
Statistical Analyses .........................................................................................................30 
9.4.1. 
General considerations ....................................................................................................31 
9.4.2. 
Primary endpoint .............................................................................................................31 
9.4.3. 
Secondary endpoint(s) ....................................................................................................31 
9.4.4. 
Tertiary/exploratory endpoint(s) .....................................................................................31 
9.4.5. 
Other safety Analyses .....................................................................................................31 
9.5. 
Interim Analyses .............................................................................................................31 
9.6. 
Data Monitoring Committee (DMC) ..............................................................................31 
10. 
Supporting Documentation and Operational Considerations ..................................32 
10.1. 
Appendix 1: Regulatory, Ethical, and Study Oversight 
Considerations ................................................................................................................32 
10.1.1. Regulatory and Ethical Considerations ...........................................................................32 
10.1.2. Financial Disclosure ........................................................................................................32 
10.1.3. Informed Consent Process ..............................................................................................33 


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10.1.4. Data Protection................................................................................................................33 
10.1.5. Clinical Monitoring .........................................................................................................33 
10.1.6. Data Quality Assurance ..................................................................................................34 
10.1.7. Source Documents ..........................................................................................................35 
10.1.8. Study and Site Start and Closure ....................................................................................36 
10.1.9. Publication Policy ...........................................................................................................36 
10.2. 
Appendix 2: Clinical Laboratory Tests ...........................................................................37 
10.3. 
Appendix 3: Adverse Events: Definitions and Procedures for 
Recording, Evaluating, Follow-up, and Reporting .........................................................38 
10.3.1. Definition of AE .............................................................................................................38 
10.3.2. Definition of SAE ...........................................................................................................39 
10.3.3. Recording and Follow-Up of AE and/or SAE ................................................................40 
10.3.4. Reporting of SAEs ..........................................................................................................42 
10.4. 
Appendix 4: Contraceptive Guidance and Collection of 
Pregnancy Information ...................................................................................................44 
10.5. 
Appendix 5: International Classification of Headache Disorders, 
3rd edition: Migraine with and without aura ...................................................................46 
10.6. 
Appendix 6: Abbreviations .............................................................................................48 
11. 
References ......................................................................................................................50 
 


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1. 
Protocol Summary 
1.1. 
Synopsis 
Protocol Title: A Multicenter, Open Label Study Assessing the Efficacy of AJOVY® 
(fremanezumab-vfrm) on Interictal Migraine Related Burden 
 
Objectives and Endpoints: 
 
Objectives 
Endpoints 
Primary 
1. To evaluate the efficacy of 
fremanezumab-vfrm on interictal 
migraine related burden between 50% 
responders and non-responders, via 
change in Migraine Interictal Burden 
Scale (MIBS-4) score during the 12-week 
treatment phase. 
1. Change in monthly Migraine Interictal 
Burden Scale (MIBS-4) scores from 
baseline to each 4-week treatment period 
during the 12-week treatment period 
comparing between 50% responders and 
non-responders within subjects treated 
with fremanezumab-vfrm. 
 
Secondary 
To evaluate the efficacy of fremanezumab-
vfrm between 50% responders and non-
responders on the following parameters 
during the 12-week treatment phase: 
 
 
1. Change in migraine days 
2. Change in Neuro-QoL Sleep 
Disturbance Short Form (SDSF) 
3. Change in General Self-Efficacy Short 
Form (GSE-SF) 
4. Change in PROMIS-29 
5. Change in Work Productivity and 
Activity Impairment- Migraine 
(WPAI-M)  
Change from baseline to each 4-week 
treatment period during the 12-week 
treatment period comparing between 50% 
responders and non-responders within 
subjects treated with fremanezumab-vfrm on 
the following: 
1. Number of migraine days 
2. Neuro-QoL Sleep Disturbance 
Short Form (SDSF) scores 
3. General Self-Efficacy Short Form 
(GSE-SF) scores 
4. PROMIS 29 scores 
5. Work Productivity and Activity 
Impairment- Migraine (WPAI-M) 
scores 


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Objectives 
Endpoints 
6. Change in Brief Measure of Worry 
Severity (BMWS) 
7. To evaluate the safety and tolerability 
of subjects treated with 
fremanezumab-vfrm 
 
6. Brief Measure of Worry Severity 
(BMWS) scores 
7. Safety and tolerability of 
fremanezumab-vfrm in study 
participants via collection of 
adverse events and safety 
evaluations. 
 
Exploratory 
To evaluate the efficacy of fremanezumab-
vfrm between 50% responders and non-
responders on the following parameters 
during a 12-week treatment phase: 
1. Change in activity and sleep measured 
though a wearable device 
1. Change from baseline to each 4-week 
treatment period during the 12-week 
treatment period comparing between 50% 
responders and non-responders within 
subjects treated with fremanezumab-vfrm 
on activity and sleep measured though a 
wearable device. 
 
Overall Design: 
This is a single group, multicenter, open-label study with a study population of patients who 
meet International Classification of Headache Disorders 3rd edition (ICHD-III) criteria for 
migraine with or without aura and have 4 to 22 migraine days per month. 
Disclosure Statement: 
This is a single-group supportive care study with one arm and no masking. 
Number of Participants: 
A maximum of 40 participants will be enrolled to study intervention.  
Note: "Enrolled" means a participant's, or their legally acceptable representative’s, agreement to 
participate in the clinical study following completion of the informed consent process and the 4-
week run-in period. Potential participants who are screened for the purpose of determining 
eligibility for the study, but do not participate in the study via at least one administration of IP, 
are not considered enrolled. 


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Intervention Groups and Duration:  
All participants in this single-group study will complete a 4-week run-in period. After the 
run-in period, eligible participants will be enrolled to study intervention and enter a 12-
week treatment period. 
Data Monitoring Committee: No 


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1.2. 
Schedule of Activities (SoA) 
 
Procedure 
Screening 
Treatment 
Early Discontinuation 
Visit 1  
 
Day -33 to Day -28 
Visit 2 
(Enrollment) 
Day 1 
Visit 3 
 
Day 29 
± 3 
Visit 4 
 
Day 57 
± 3 
Visit 5 
 
Day 85 
± 3 
 
Informed consent 
X 
 
 
 
 
 
Height 
X 
 
 
 
 
 
Weight 
X 
X 
X 
X 
X 
X 
Vital signs 
X 
X 
X 
X 
X 
X 
Demography 
X 
 
 
 
 
 
Physical examination 
X 
X 
X 
X 
X 
X 
Neurological examination 
X 
 
 
 
 
 
Medical history 
(includes migraine history and substance usage) 
X 
 
 
 
 
 
Prior and concomitant medications history 
X 
 
 
 
 
 
Urine pregnancy test 
(WOCBP only) 
X 
X 
X 
X 
X 
X 
Laboratory assessments 
(CMP)  
X 
 
 
 
X 
X 
12-lead ECG 
X 
 
 
 
X 
X 


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Procedure 
Screening 
Treatment 
Early Discontinuation 
Visit 1  
 
Day -33 to Day -28 
Visit 2 
(Enrollment) 
Day 1 
Visit 3 
 
Day 29 
± 3 
Visit 4 
 
Day 57 
± 3 
Visit 5 
 
Day 85 
± 3 
 
PHQ-9 
X 
X 
X 
X 
X 
X 
Inclusion and exclusion criteria 
X 
X 
 
 
 
 
Dispense activity tracker 
X 
 
 
 
 
 
Dispense diary URL and instructions 
X 
 
 
 
 
 
Migraine Interictal Burden Scale (MIBS-4) 
X 
X 
X 
X 
X 
X 
Neuro-QoL Sleep Disturbance Short Form (SDSF) 
 
X 
X 
X 
X 
X 
PROMIS-29 
 
X 
X 
X 
X 
X 
Work Productivity and Activity Impairment- 
Migraine (WPAI-M) 
 
X 
X 
X 
X 
X 
General Self-Efficacy Short Form (GSE-SF) 
 
X 
X 
X 
X 
X 
Brief Measure of Worry Severity (BMWS) 
 
X 
X 
X 
X 
X 
AE review 
 
X 
X 
X 
X 
X 
SAE review 
 
X 
X 
X 
X 
X 
Diary review 
 
X 
X 
X 
X 
X 
Concomitant medication review 
 
X 
X 
X 
X 
X 
IP injection 
 
X 
X 
X 
 
 


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2. 
Introduction 
2.1. 
Study Rationale 
This study is being conducted to evaluate the efficacy and safety of fremanezumab-vfrm on 
interictal migraine related burden in adult participants age 18 to 65 years old, who meet 
International Classification of Headache Disorders 3rd edition (ICHD-III; Appendix 5) criteria 
for migraine with or without aura and have 4 to 22 migraine days per month.  
2.2. 
Background 
The burden of Migraine can extend well beyond the pain phase and affect more than just work 
and school attendance. Patients with frequent Episodic Migraine and Chronic Migraine are 
known to experience the impact of migraine even on days they do not have migraine pain or 
associated symptoms such as nausea, photophobia, or phonophobia. Most of the focus of 
migraine management is placed on migraine pain and associated symptom relief and the 
interictal burden of migraine is often overlooked.  
 
Individuals experiencing frequent migraine attacks regularly find themselves engaged in 
preparatory or compensatory behaviors, hoping to minimize lost productivity or compromised 
quality of life, even before attacks begin. These types of behaviors originate from the fear and 
dread of the inevitable migraine attacks to come and lead to a significant diminution of quality of 
life before the pain has even started1,2. Patients frequently cancel plans with family and friends or 
avoid making commitments in the first place based on their anticipation of a migraine episodes. 
Even worse, these fears and behavior changes also tend to exacerbate co-occurring conditions 
such as anxiety, depression, and sleep disorders, further contributing to poor quality of life. 
Unfortunately, migraine prevention trials have traditionally focused on reduction of migraine 
days as a primary endpoint and have largely ignored the significant health and lifestyle burdens 
also associated with migraine and associated symptoms. 
2.3. 
Significance 
This study aims to capture changes in functional impact, including but not limited to the 
assessment of the interictal burden of migraine after participants begin treatment with 
fremanezumab-vfrm. In addition to using a variety of scales to capture these changes this study 
will use activity trackers to allow detailed monitoring of daily activity and sleep patterns. This 
approach has been used in a variety of clinical trials over a wide range of disease states with 
success and its addition will enrich the results obtained through administration of traditional 
questionnaires. Specific assessments of worry, work productivity, and self-efficacy will 


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complement the overall impact of patients’ lives directly and indirectly related to response to 
CGRP blockade. It is hypothesized that participants treated with fremanezumab-vfrm will 
demonstrate improvements in a variety of measures of daily activity and attitudes. Results from 
this study will be a significant contribution to the medical literature and bring value to providers 
as they manage expectations with patients regarding the functional impact of fremanezumab-
vfrm on migraine prophylaxis efforts. Moreover, this study aims to bridge the gap between the 
traditional focus on reduction of migraine days as a primary endpoint and the numerous other 
significant health and lifestyle burdens also associated with migraine and associated symptoms. 
2.4. 
Benefit/Risk Assessment 
Detailed information about the known and expected benefits and risks and reasonably expected 
adverse events of fremanezumab-vfrm may be found in the Package Insert. 


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3. 
Objectives and Endpoints 
Objectives 
Endpoints 
Primary 
1. To evaluate the efficacy of 
fremanezumab-vfrm on interictal 
migraine related burden between 50% 
responders and non-responders, via 
change in Migraine Interictal Burden 
Scale (MIBS-4) score during the 12-week 
treatment phase. 
1. Change in monthly Migraine Interictal 
Burden Scale (MIBS-4) scores from 
baseline to each 4-week treatment period 
during the 12-week treatment period 
comparing between 50% responders and 
non-responders within subjects treated 
with fremanezumab-vfrm. 
Secondary 
To evaluate the efficacy of fremanezumab-
vfrm between 50% responders and non-
responders on the following parameters 
during the 12-week treatment phase: 
 
 
1. Change in migraine days 
2. Change in Neuro-QoL Sleep 
Disturbance Short Form (SDSF) 
3. Change in General Self-Efficacy Short 
Form (GSE-SF) 
4. Change in PROMIS-29 
5. Change in Work Productivity and 
Activity Impairment- Migraine 
(WPAI-M)  
6. Change in Brief Measure of Worry 
Severity (BMWS) 
7. To evaluate the safety and tolerability 
of subjects treated with 
fremanezumab-vfrm 
 
Change from baseline to each 4-week 
treatment period during the 12-week 
treatment period comparing between 50% 
responders and non-responders within 
subjects treated with fremanezumab-vfrm on 
the following: 
1. Number of migraine days 
2. Neuro-QoL Sleep Disturbance 
Short Form (SDSF) scores 
3. General Self-Efficacy Short Form 
(GSE-SF) scores 
4. PROMIS 29 scores 
5. Work Productivity and Activity 
Impairment- Migraine (WPAI-M) 
scores 
6. Brief Measure of Worry Severity 
(BMWS) scores 
7. Safety and tolerability of 
fremanezumab-vfrm in study 
participants via collection of 
adverse events and safety 
evaluations. 
 


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Objectives 
Endpoints 
Exploratory 
To evaluate the efficacy of fremanezumab-
vfrm between 50% responders and non-
responders on the following parameters 
during a 12-week treatment phase: 
1. Change in activity and sleep measured 
though a wearable device 
1. Change from baseline to each 4-week 
treatment period during the 12-week 
treatment period comparing between 50% 
responders and non-responders within 
subjects treated with fremanezumab-vfrm 
on activity and sleep measured though a 
wearable device. 


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Page 15 of 50 
 
4. 
Study Design 
 
4.1. 
Overall Design 
This is a multicenter, open label study assessing the interictal impact of fremanezumab-vfrm in 
participants with migraine. The study population will consist of 40 participants 18 to 65 years 
old, with at least 4 and up to 22 migraine days per month (inclusive) following ICHD-III criteria 
for migraine with or without aura. 
 
At Visit 1, the participant will sign the informed consent indicating they are willing to participate 
in the study and will provide basic demographic information, have a comprehensive review of 
their medical history and prior and concomitant medications. The subject’s migraine history will 
be reviewed and confirmed in accordance with the ICHD-III, by the PI or an appropriately 
delegated and qualified sub-Investigator. A physical and neurological examination (including 
vital signs) will be performed as well as a 12-lead Electrocardiography (ECG), screening 
comprehensive metabolic panel (CMP) labs, and the PHQ-9 will be completed. Women of 
childbearing potential (WOCBP) will complete a urine pregnancy test. All participants will 
complete the MIBS-4 questionnaire. Inclusion and Exclusion criteria will also be reviewed. 
Participants who meet the study criteria will be dispensed the activity tracker and its associated 
phone application instructions, as well as their unique Daily Headache Diary (DHD) URL and its 
instructions. Participants will then enter into a 28-day run-in period.  During the 28-day run-in 
period, all participants will be monitored through the use of electronic Daily Headache Diary 
(DHD) to ensure they continue to meet all inclusion criteria, and none of the exclusion criteria. 
During this run-in period, participants will continue treating their migraines and other defined 
conditions with their usual treatment providing it has been stable for a minimum of 3 months. 
Daily electronic diaries will be used to assess symptoms and treatment response throughout the 
run-in period. 
 
Visit 2 will take place 28 to 33 days following Visit 1. Those participants who (1) continue to 
meet eligibility criteria (2) experienced 4-22 migraine days that meet ICHD-III criteria for 
migraine and (3) have completed at least 23/28 diary days will be eligible to be enrolled into the 
study. At this visit a physical examination (including vital signs) will be performed, WOCBP 
will complete a urine pregnancy test, and all participants will complete the PHQ-9. Medical 
history and/or adverse events and concomitant medications will be reviewed and updated as 
needed. Participant’s DHD will be reviewed for compliance, and participants will complete the 
following questionnaires: 
• MIBS-4 


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Page 16 of 50 
 
• SDSF 
• PROMIS-29 
• MPAI-M 
• BMWS 
• GSE-SF 
Finally, all eligible participants will receive an injection of 225 mg fremanezumab-vfrm. 
Participants will continue completing diary headache diaries for the remainder of the trial. 
 
Visits 3-5 will take place on days 29 (+/-3d), 57 (+/-3d), and 85 (+/-3d), following Visit 2.  At 
each visit: a physical examination (including vital signs) will be performed, WOCBP will 
complete a urine pregnancy test, and all participants will complete the PHQ-9. Medical history 
and/or adverse events and concomitant medications will be reviewed and updated as needed. 
Participant’s DHD will be reviewed for compliance, and participants will complete the following 
questionnaires: 
• MIBS-4 
• SDSF 
• PROMIS-29 
• MPAI-M 
• BMWS 
• GSE-SF 
Finally, all eligible participants will receive an injection of 225 mg fremanezumab-vfrm at visits 
3 and 4. Visit 5 (End of Study) will not include injections but will include comprehensive 
metabolic panel (CMP) laboratory. 
4.2. 
End of Study Definition 
A participant is considered to have completed the study if he or she has completed all phases of 
the study including the last visit (Visit 5) or the last scheduled procedure shown in the SoA. 
The end of the study is defined as completion of the last visit or procedure shown in the SoA in 
the trial globally. 


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5. 
Study Population 
Prospective approval of protocol deviations to recruitment and enrollment criteria, also known as 
protocol waivers or exemptions, is not permitted. 
5.1. 
Inclusion Criteria 
 
Participants are eligible to be included in the study only if all of the following criteria apply: 
1. willing to participate and sign informed consent; 
2. ability to read and understand informed consent and study procedures, including able to 
use the electronic Daily Headache Diary; 
3. in good general health based on investigator’s judgment; 
4. must be between 18 to 65 years of age, inclusive, at time of Visit 2; 
5. have migraine with and/or without aura meeting the diagnostic criteria listed in the 
International Classification of Headache Disorders 3rd edition (ICHD-III; Appendix 5); 
6. verification of headache frequency through prospectively collected baseline information 
during the 28-day screening/baseline phase reporting 4-22 migraine days and no more 
than 22 total headache days; 
7. onset of migraine before age 50; 
8. able to differentiate migraine from other primary headache types allowed in the study 
(e.g., tension-type headache); 
9. stable history of migraine at least 3 months prior to screening with at least some discreet 
headache free periods; 
10. not currently taking a migraine preventive OR has been taking a stable dose of a 
preventive for at least 90 days prior to screening and agrees to not start, stop, or change 
medication and/or dosage during the study period; 
* * participants on migraine preventive should have stable headache pattern  
11. women may be included only if they have a negative pregnancy test at screening and 
baseline, are sterile, or postmenopausal. Women of childbearing potential (WOCBP) 
engaging in potentially procreative intercourse must use highly effective birth control 
methods for the duration of the study (i.e., starting at screening). Definitions of WOCBP, 
sterile and postmenopausal women, male contraception, and highly effective and 
acceptable birth control methods are to be determined based on investigator’s judgment; 


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12. demonstrated compliance with the electronic Daily Headache Diary during the 28-day 
screening/baseline phase as defined by entry of headache data on a minimum of 23 days; 
13. is willing to wear activity/sleep tracker throughout the duration of the trial; 
14. has a smartphone and willing to install activity tracker app on phone. 
5.2. 
Exclusion Criteria  
Participants are excluded from the study if any of the following criteria apply: 
1. unable to understand the study requirements, the informed consent, or complete headache 
records as required per protocol; 
2. pregnant, actively trying to become pregnant, or breast-feeding;  
3. history of substance abuse and/or dependence that would interfere study conduction, in 
the opinion of the Investigator; 
4. history of impaired renal function that, in the investigator’s opinion, contraindicates 
participation in this study; 
5. suffers from a serious illness, or an unstable medical condition, one that could require 
hospitalization, increase the risk of adverse events, or compromise data integrity (ie, 
likely require changes in con meds or lead to other medical investigations or treatments 
during the study). 
6. a psychiatric condition, in the opinion of the investigator, that may affect the 
interpretation of efficacy and safety data or contraindicates the participant’s participation 
in the study; 
7. received nerve blocks or trigger point injections in the previous 8 weeks or plans to 
receive them during the study; 
8. prior exposure in the last 6 months, or 5 half-lives, to biologics or drugs specifically 
targeting the calcitonin gene-related peptide (CGRP) pathway; 
9. has failed more than 3 classes of medications for the prevention of migraine or >6 
migraine preventive medications of any type due to lack of efficacy; 
10. received any investigational agents within 30 days prior to Visit 1 (6 months for any 
investigational biological products unless previous study blind has been broken and 
subject was known to have received placebo); 
11. plans to participate in another clinical study at any time during this study; 
12. history of medication overuse of opioids or butalbital, as defined by opioid or butalbital 
use ≥10 days/month in each of the previous 3 months or during run-in period; Medication 


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Overuse Headache (MOH) with other medication types will be allowed but must be 
documented; 
13. unstable medication use for migraine prevention (changes in the last 3 months);  
14. clinically relevant lab results at screening as determined by the investigator; 
15. clinically relevant or significant ECG abnormalities as determined by the investigator, 
including ECG with QT interval corrected for heart rate (QTc) using Fridericia's 
correction formula (QTcF) > 500 msec; 
16. history of any of the following cardiovascular conditions: 
a. Moderate to severe congestive heart failure (New York Heart Association class III 
or IV); 
b. Recent (within past 6 months) cerebrovascular accident, myocardial infarction, 
coronary stenting; 
c. Uncontrolled hypertension as defined by a confirmed systolic blood pressure > 
160 mmHg or diastolic blood pressure > 100 mmHg.  
17. Subjects known to have active HIV or untreated Hepatitis C infection; 
18. score of > 0 on question 9 on Patient Health Questionnaire (PHQ-9) at any visit; 
19. have any other condition, that in the judgment of the investigator, would make the 
participant unsuitable for inclusion, or would interfere with the participant participating 
in or completing the study. 
5.3. 
Screen Failures 
Screen failures are defined as participants who consent to participate in the clinical study but are 
not subsequently assigned to study intervention at Visit 2. A minimal set of screen failure 
information is required to ensure transparent reporting of screen failure participants to meet the 
Consolidated Standards of Reporting Trials (CONSORT) publishing requirements and to 
respond to queries from regulatory authorities. Minimal information includes demography, 
screen failure details, eligibility criteria, and any serious adverse event (SAE). 
Individuals who do not meet the criteria for participation in this study (screen failure) may be 
permitted in certain situations to rescreen, after discussion with the study medical monitor. 
However, participants that test positive, through urine testing, as pregnant, or are determined to 
be of significant suicide risk, are not allowed to be rescreened. 
Rescreened participants should be assigned a new participant number (i.e., different than the 
initial screening participant number). 


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6. 
Study Intervention 
6.1. 
Study Intervention(s) Administered 
Description: 
Fremanezumab-vfrm is a calcitonin gene-related peptide (CGRP) antagonist subcutaneous 
injection indicated for the preventive treatment of migraine in adults, see product insert for 
detailed information. 
Dosing and administration: 
225 mg/1.5 mL solution via single-dose prefilled syringe administered subcutaneously once 
monthly in the abdomen, thigh, or upper arm. 
 
6.2. 
Preparation/Handling/Storage/Accountability 
1. The investigator or appropriately trained and delegated designee must confirm 
appropriate temperature conditions have been maintained during transit for all study 
intervention received and any discrepancies are reported and resolved before use of the 
study intervention. 
2. Only participants enrolled in the study may receive study intervention and only 
authorized site staff may supply or administer study intervention. All study intervention 
must be stored in a secure, environmentally controlled, and monitored (manual or 
automated) area in accordance with the labeled storage conditions with access limited to 
the investigator and authorized site staff. 
3. The investigator, institution, or the head of the medical institution (where applicable) is 
responsible for investigational product accountability, reconciliation, and record 
maintenance (i.e., receipt, reconciliation, and final disposition records). 
4. Further guidance and information for the storage and final disposition of unused 
investigational product are provided in the Package Insert. 
5. See the Package Insert for complete preparation, handling, storage, and accountability 
details. 
6.3. 
Measures to Minimize Bias: Randomization and Blinding 
This is an open-label study with one arm; potential randomization and/or blinding concerns are 
not applicable. 
 


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6.4. 
Study Intervention Compliance 
All participants will be dosed at the site and will receive study intervention directly from the 
investigator or designee, under medical supervision.  The date and time of each dose 
administered in the clinic will be recorded in the source documents and recorded in the Case 
report form (CRF). 
6.5. 
Concomitant Therapy 
Any medication or vaccine (including over-the-counter or prescription medicines, vitamins, 
and/or herbal supplements) that the participant is receiving at the time of enrollment or receives 
during the study must be recorded along with: 
• Reason for use 
• Dates of administration including start and end dates 
• Dosage information including dose and frequency 
The Medical Monitor should be contacted if there are any questions regarding concomitant or 
prior therapy. 
Participants should not currently be taking a migraine preventive or have been taking a stable 
dose of a preventive for at least 90 days prior to screening and agrees to not start, stop, or change 
medication and/or dosage during the study period. 
6.5.1. 
Prohibited Medications 
Nerve blocks or trigger point injections in the previous 8 weeks prior to study or at any time 
during the study are prohibited. Prior exposure to biologics or drugs specifically targeting the 
CGRP pathway in the 6 months, or 5 half-lives, prior to or during the study are also prohibited. 
 


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7. 
Discontinuation of Study Intervention and Participant 
Discontinuation/Withdrawal 
7.1. 
Discontinuation of Study Intervention 
In rare instances, it may be necessary for a participant to permanently discontinue (definitive 
discontinuation) study intervention. If study intervention is definitively discontinued, the 
participant will not remain in the study. See the SoA for data to be collected at the time of 
discontinuation of study intervention and for any further evaluations that need to be completed. 
7.2. 
Participant Discontinuation/Withdrawal from the Study 
• 
A participant may withdraw from the study at any time at his/her own request, or may 
be withdrawn at any time at the discretion of the investigator for safety, behavioral, 
compliance, or administrative reasons. This is expected to be uncommon. 
• 
At the time of discontinuing from the study, if possible, an early discontinuation visit 
should be conducted, as shown in the SoA. See SoA for data to be collected at the time 
of study discontinuation and follow-up and for any further evaluations that need to be 
completed. 
• 
The participant will be permanently discontinued both from the study intervention and 
from the study at that time. 
• 
If the participant withdraws consent for disclosure of future information, the sponsor 
may retain and continue to use any data collected before such a withdrawal of consent. 
• 
If a participant withdraws from the study, he/she may request destruction of any 
samples taken and not tested, and the investigator must document this in the site study 
records. 
7.3. 
Lost to Follow up 
A participant will be considered lost to follow-up if he or she repeatedly fails to return for 
scheduled visits and is unable to be contacted by the study site. 
The following actions must be taken if a participant fails to return to the clinic for a required 
study visit: 
• 
The site must attempt to contact the participant and reschedule the missed visit as soon 
as possible and counsel the participant on the importance of maintaining the assigned 
visit schedule and ascertain whether or not the participant wishes to and/or should 
continue in the study. 


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• 
Before a participant is deemed lost to follow up, the investigator or designee must make 
every effort to regain contact with the participant (where possible, 3 telephone calls and, 
if necessary, a certified letter to the participant’s last known mailing address or local 
equivalent methods). These contact attempts should be documented in the participant’s 
medical record. 
• 
Should the participant continue to be unreachable, he/she will be considered to have 
withdrawn from the study.  
Discontinuation of specific sites or of the study as a whole are handled as part of Appendix 1. 


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Page 24 of 50 
 
8. 
Study Assessments and Procedures 
• 
Study procedures and their timing are summarized in the SoA. Protocol waivers or 
exemptions are not allowed. 
• 
Immediate safety concerns should be discussed with the sponsor immediately upon 
occurrence or awareness to determine if the participant should continue or discontinue 
study intervention. 
• 
Adherence to the study design requirements, including those specified in the SoA, is 
essential and required for study conduct. 
• 
All screening evaluations must be completed and reviewed to confirm that potential 
participants meet all eligibility criteria. The investigator will maintain a screening log to 
record details of all participants screened and to confirm eligibility or record reasons for 
screening failure, as applicable. 
8.1. 
Efficacy Assessments 
8.1.1. 
Migraine Interictal Burden Scale (MIBS-4)  
Participants will complete an electronic version of the MIBS-4 within the clinic during visits 
outlined in the SoA. 
8.1.2. 
Migraine Days via Daily Headache Diary (DHD) 
Headache and Migraine data will be recorded by the participants into an electronic daily 
headache diary (DHD) throughout the study. The DHDs are web-based and can be completed on 
any internet enabled device. Participants will be given their unique DHD URL at Visit 1. Site 
personnel will be responsible for instructing participants on the requirement for timely and daily 
completion of the DHD. Participants will be asked to record diary data each day for the previous 
day (24-hour period). If a participant does not experience a headache in the previous 24-hour 
period, the diary must still be completed as instructed. Participant’s diaries may vary day to day 
based on their responses. All participants should have at least 80% compliance with diary 
completion throughout the length of the study. Participants will record headache severity, 
symptoms, use of acute medications, as well as additional assessments as required. 
8.1.3. 
Neuro-QoL Sleep Disturbance Short Form (SDSF) 
Participants will complete an electronic version of the SDSF within the clinic during visits 
outlined in the SoA. 


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8.1.4. 
General Self-Efficacy Short Form (GSE-SF) 
Participants will complete an electronic version of the GSESS within the clinic during visits 
outlined in the SoA. 
8.1.5. 
PROMIS-29 
Participants will complete an electronic version of the PROMIS-29 within the clinic during visits 
outlined in the SoA. 
8.1.6. 
Work Productivity and Activity Impairment- Migraine (WPAI-M) 
Participants will complete an electronic version of the WPAI-M within the clinic during visits 
outlined in the SoA. 
8.1.7. 
Brief Measure of Worry Severity (BMWS) 
Participants will complete an electronic version of the BMWS within the clinic during visits 
outlined in the SoA. 
8.1.8. 
Activity and Sleep via wearable device 
Participants’ activity and sleep data will be recorded via a sponsor-provided wearable device 
(e.g., Fitbit or similar). Participants may also be required to install the wearable device’s phone 
application on their personal phones in order for the data to be transferred to the sponsor. Site 
personnel will be responsible for instructing participants on the requirement(s) of the wearable 
device and its associated phone application if applicable. 
8.2. 
Safety Assessments 
Planned time points for all safety assessments are provided in the SoA. 
8.2.1. 
Physical and Neurological Examinations 
• 
A complete physical examination will include, at a minimum, assessments of the 
Cardiovascular, Respiratory, and Gastrointestinal systems. Height and weight will also 
be measured and recorded. 
• 
A complete neurological examination will be performed. 
• 
Investigators should pay special attention to clinical signs related to previous serious 
illnesses. 
8.2.2. 
Vital Signs 
• 
Oral temperature, pulse rate, respiratory rate, and blood pressure will be assessed. 
• 
Blood pressure and pulse measurements will be assessed. 


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• 
Blood pressure and pulse measurements should be preceded by at least 5 minutes of rest 
for the participant in a quiet setting without distractions (e.g., television, cell phones). 
• 
Vital signs will be measured in a semi-supine position after 5 minutes rest and will 
include temperature, systolic and diastolic blood pressure, and pulse. 
8.2.3. 
Electrocardiograms 
• 
12-lead ECG’s will be obtained as outlined in the SoA (see Section 1.3). The heart rate, 
PR, QRS, QT, and QTc intervals will be measured/calculated. Investigators will read 
final EKG’s and determine any abnormalities. The overall interpretation and 
determination of the clinical relevance of ECG findings will be the responsibility of the 
investigator  
8.2.4. 
Clinical Safety Laboratory Assessments 
• 
See Appendix 2 for the list of clinical laboratory tests to be performed and to the SoA 
for the timing and frequency. 
• 
The investigator must review the laboratory report, document this review, and record 
any clinically relevant changes occurring during the study in the AE section of the CRF. 
The laboratory reports must be filed with the source documents. Clinically significant 
abnormal laboratory findings are those which are not associated with the underlying 
disease, unless judged by the investigator to be more severe than expected for the 
participant's condition. 
• 
All laboratory tests with values considered clinically significantly abnormal during 
participation in the study should be repeated until the values return to normal or 
baseline or are no longer considered clinically significant by the investigator or medical 
monitor. 
o If such values do not return to normal/baseline within a period of time judged 
reasonable by the investigator, the etiology should be identified and Clinvest and the 
medical monitor notified. 
o All protocol-required laboratory assessments, as defined in Appendix 2, must be 
conducted in accordance with the SoA. 
o If laboratory values from non-protocol specified laboratory assessments performed at 
the institution’s local laboratory require a change in participant management or are 
considered clinically significant by the investigator (e.g., SAE or AE or dose 
modification), then the results must be recorded in the CRF. 


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8.2.5. 
Suicidal Ideation and Behavior Risk Monitoring 
Participants being treated with fremanezumab-vfrm should be monitored appropriately and 
observed closely for suicidal ideation and behavior or any other unusual changes in behavior, 
especially at the beginning and end of the course of intervention, or at the time of dose changes, 
either increases or decreases. Consideration should be given to discontinuing the study 
medication in participants who experience signs of suicidal ideation or behavior, following a risk 
assessment.  
Baseline assessment of suicidal ideation and behavior/ intervention emergent suicidal ideation 
and behavior will be monitored during the study using PHQ-9.  
8.3. 
Adverse Events and Serious Adverse Events 
AEs will be reported by the participant (or, when appropriate, by a caregiver, surrogate, or the 
participant's legally authorized representative). 
The investigator and any qualified designees are responsible for detecting, documenting, and 
recording events that meet the definition of an AE or SAE and remain responsible for following 
up AEs that are serious, considered related to the study intervention or study procedures, or that 
caused the participant to discontinue the study intervention or study (see Section 7). 
8.3.1. 
Time Period and Frequency for Collecting AE and SAE Information 
All SAEs will be collected from the signing of the informed consent form (ICF) until Visit 5 as 
specified in the SoA (Section 1.3). 
All AEs will be collected from the start of intervention until Visit 5 as specified in the SoA 
(Section 1.3). 
Medical occurrences that begin before the start of study intervention but after obtaining informed 
consent will be recorded on the Medical History/Current Medical Conditions section of the CRF 
not the AE section. 
All SAEs will be recorded and reported to the sponsor or designee immediately and under no 
circumstance should this exceed 24 hours, as indicated in Appendix 3. The investigator will 
submit any updated SAE data to the sponsor within 24 hours of it being available. 
Investigators are not obligated to actively solicit reports of AE’s or SAE’s after conclusion of the 
study participation. However, if the investigator learns of any SAE, including a death, within five 
half-lives after a participant has been discharged from the study, and he/she considers the event 
to be reasonably related to the study intervention or study participation, the investigator must 
promptly notify the sponsor. 


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8.3.2. 
Method of Detecting AEs and SAEs 
The method of recording, evaluating, and assessing causality of AE and SAE and the procedures 
for completing and transmitting SAE reports are provided in Appendix 10.3. 
Care will be taken not to introduce bias when detecting AEs and/or SAEs. Open-ended and 
non-leading verbal questioning of the participant is the preferred method to inquire about 
AE occurrences. 
8.3.3. 
Follow-up of AEs and SAEs 
After the initial AE/SAE report, the investigator is required to proactively follow each participant 
at subsequent visits/contacts. All SAEs, and AEs will be followed until resolution, stabilization, 
the event is otherwise explained, or the participant is lost to follow-up (as defined in Section 
7.3). Further information on follow-up procedures is provided in Appendix 10.3. 
8.3.4. 
Regulatory Reporting Requirements for SAEs 
• 
Prompt notification by the investigator to the sponsor of a SAE is essential so that legal 
obligations and ethical responsibilities towards the safety of participants and the safety 
of a study intervention under clinical investigation are met. 
• 
The sponsor has a legal responsibility to notify both the local regulatory authority and 
other regulatory agencies about the safety of a study intervention under clinical 
investigation. The sponsor will comply with country-specific regulatory requirements 
relating to safety reporting to the regulatory authority, Institutional Review Boards 
(IRB)/Independent Ethics Committees (IEC), and investigators. 
• 
For all studies except those utilizing medical devices investigator safety reports must be 
prepared for suspected unexpected serious adverse reactions (SUSAR) according to 
local regulatory requirements and sponsor policy and forwarded to investigators as 
necessary. 
• 
An investigator who receives an investigator safety report describing a SAE or other 
specific safety information (e.g., summary or listing of SAEs) from the sponsor will 
review and then file it along with the Investigator’s Brochure and will notify the 
IRB/IEC, if appropriate according to local requirements. 
8.3.5. 
Pregnancy 
• 
Details of all pregnancies in female participants and, female partners of male 
participants will be collected after the start of study intervention and until 5 terminal 
half-lives after the last dose. Pregnancies will be followed until delivery. 


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• 
If a pregnancy is reported, the investigator should inform the sponsor within 24 hours of 
learning of the pregnancy and should follow the procedures outlined in Appendix 10.4. 
• 
Abnormal pregnancy outcomes (e.g., spontaneous abortion, fetal death, stillbirth, 
congenital anomalies, ectopic pregnancy) are considered SAEs. 
8.4. 
Treatment of Overdose 
Not applicable, all treatments will be delivered in clinic by investigator or designee. 
8.5. 
Pharmacokinetics 
Not applicable, pharmacokinetic parameters are not evaluated in this study. 
8.6. 
Genetics 
Not applicable, genetics are not evaluated in this study. 
8.7. 
Biomarkers 
Not applicable, biomarkers are not evaluated in this study. 
8.8. 
Immunogenicity Assessments 
Not applicable, immunology assessments are not evaluated in this study. 
8.9. 
Medical Resource Utilization and Health Economics 
Not applicable, medical resource utilization and health economics are not evaluated in this study. 
 


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9. 
Statistical Considerations 
9.1. 
Statistical Hypotheses 
The null hypothesis of this study is that participants’ global Migraine Interictal Burden Scale 
(MIBS-4) scores will not be statistically different between 50% responders and non-responders 
from baseline (Visit 2) to any 4-week treatment period during the 12-week treatment period after 
3 months dose of 225 mg fremanezumab-vfrm. 
9.2. 
Sample Size Determination 
To determine the needed sample size for this study we utilized G*Power3 Version 3.1.9.3 to 
conduct a power analysis for the Primary Endpoint analysis (repeated measures ANOVA, 
within-between interaction) comparing baseline MIBS-4 scores to treatment month(s) MIBS-4 
scores between 50% responders and non-responders. Based on prior research, we expect an 
approximate equal proportion of responders and non-responders in this open-label study. The 
power analysis indicated that a total of 36 subjects would be adequate to detect a medium effect 
(f = 0.25), with alpha set at 0.05, and a power of .95. To account for a 10% early withdrawal rate, 
a total of 40 subjects should be enrolled in the study. 
9.3. 
Populations for Analyses 
The following populations are defined: 
Population 
Description 
Full Analysis Population 
All participants enrolled and with at least one administration of 
IP, will be included in this study population. The Full Analysis 
Population will be used to analyze the primary efficacy and 
safety endpoints 
Note: Other populations may be defined in the SAP. 
9.4. 
Statistical Analyses 
The statistical analysis plan (SAP) will be finalized prior to database lock and it will include a 
more technical and detailed description of the statistical analyses described in this section. This 
section is a summary of the planned statistical analyses of the most important endpoints 
including primary and key secondary endpoints. In case of a discrepancy, the SAP will supersede 
the protocol.  


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9.4.1. General considerations 
An alpha of .05 will be used for statistical significance for all statistical tests.  All statistically 
significant multivariate analyses will be followed by univariate post-hoc tests.  Appropriate 
multiple comparison adjustments will be made if needed. A Last Observation Carried Forward 
(LOCF) method will be utilized to impute missing data where appropriate. 
9.4.2. 
Primary endpoint 
Data for the primary endpoint will be statistically analyzed via a repeated measures ANOVA, 
within-between interaction comparing baseline MIBS-4 scores to treatment month(s) MIBS-4 
scores between 50% responders and non-responders. 
9.4.3. 
 Secondary endpoint(s) 
Data for each of the secondary outcome measures will be statistically analyzed for within and 
between group changes via analysis of variance (ANOVA), t-tests, or chi-square tests as 
appropriate. 
9.4.4. 
Tertiary/exploratory endpoint(s) 
The Statistical Analysis Plan will describe any planned tertiary/exploratory analyses in greater 
detail. 
9.4.5. 
Other safety Analyses 
There will not be a formal statistical analysis for safety endpoints (adverse events, etc.); 
however, all adverse events will be summarized via tables and descriptive statistics as 
appropriate. 
9.5. 
Interim Analyses  
Not Applicable, i.e., there is not a planned interim analysis for this study. 
9.6. 
Data Monitoring Committee (DMC) 
Not Applicable, i.e., there is not a DMC for this study. 


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10. 
Supporting Documentation and Operational Considerations 
10.1. 
Appendix 1: Regulatory, Ethical, and Study Oversight 
Considerations 
10.1.1. 
Regulatory and Ethical Considerations 
• 
This study will be conducted in accordance with the protocol and with the following: 
o Consensus ethical principles derived from international guidelines including the 
Declaration of Helsinki and Council for International Organizations of Medical 
Sciences (CIOMS) International Ethical Guidelines 
o Applicable ICH Good Clinical Practice (GCP) Guidelines 
o Applicable laws and regulations 
• 
The protocol, protocol amendments, ICF, Investigator Brochure, and other relevant 
documents (e.g., advertisements) must be submitted to an IRB/IEC by the investigator 
and reviewed and approved by the IRB/IEC before the study is initiated. 
• 
Any amendments to the protocol will require IRB/IEC approval before implementation 
of changes made to the study design, except for changes necessary to eliminate an 
immediate hazard to study participants. 
• 
The investigator will be responsible for the following: 
o Providing written summaries of the status of the study to the IRB/IEC annually or 
more frequently in accordance with the requirements, policies, and procedures 
established by the IRB/IEC 
o Notifying the IRB/IEC of SAEs or other significant safety findings as required by 
IRB/IEC procedures 
o Providing oversight of the conduct of the study at the site and adherence to 
requirements of 21 CFR, ICH guidelines, the IRB/IEC, European regulation 536/2014 
for clinical studies (if applicable), and all other applicable local regulations 
10.1.2. 
Financial Disclosure 
Investigators and sub-investigators will provide the sponsor with sufficient, accurate financial 
information as requested to allow the sponsor to submit complete and accurate financial 
certification or disclosure statements to the appropriate regulatory authorities. Investigators are 
responsible for providing information on financial interests during the course of the study. 


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10.1.3. 
Informed Consent Process 
• 
The investigator or his/her representative will explain the nature of the study to the 
participant or his/her legally authorized representative and answer all questions 
regarding the study. 
• 
Participants must be informed that their participation is voluntary. Participants will be 
required to sign a statement of informed consent that meets the requirements of 21 CFR 
50, local regulations, ICH guidelines, Health Insurance Portability and Accountability 
Act (HIPAA) requirements, where applicable, and the IRB/IEC or study center. 
• 
The medical record must include a statement that written informed consent was 
obtained before the participant was enrolled in the study and the date the written 
consent was obtained. The authorized person obtaining the informed consent must also 
sign the ICF. 
• 
Participants must be re-consented to the most current version of the ICF(s) during their 
participation in the study. 
• 
A copy of the ICF(s) must be provided to the participant or the participant’s legally 
authorized representative.  
• 
Participants who are rescreened are required to sign a new ICF. 
10.1.4. 
Data Protection 
• 
Participants will be assigned a unique identifier. Any participant records or datasets that 
are transferred outside of study site will contain the identifier only; participant names or 
any information which would make the participant identifiable will not be transferred. 
• 
The participant must be informed that his/her personal study-related data will be used 
by the study team in accordance with local data protection law. The level of disclosure 
must also be explained to the participant who will be required to give consent for their 
data to be used as described in the informed consent  
• 
The participant must be informed that his/her medical records may be examined by 
Clinical Quality Assurance auditors or other authorized personnel appointed by the 
sponsor, by appropriate IRB/IEC members, and by inspectors from regulatory 
authorities. 
10.1.5. 
Clinical Monitoring 
Clinical site monitoring is conducted to ensure that the rights and well-being of trial participants 
are protected, the reported trial data are accurate, complete, and verifiable, and the conduct of the 
trial is in compliance with the currently approved protocol/amendment(s), with International 
Conference on Harmonization cGCP), and with applicable regulatory requirement(s).  


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• Monitoring for this study will be performed by the Contract Research Organization 
(CRO).  
• Details of clinical site monitoring are documented in a Monitoring Plan (MP). The MP 
describes in detail who will conduct the monitoring, at what frequency monitoring will be 
done, at what level of detail monitoring will be performed, and the distribution of 
monitoring reports. 
10.1.6. 
Data Quality Assurance 
• 
All participant data relating to the study will be recorded on printed or electronic CRF 
unless transmitted to the sponsor or designee electronically (e.g., laboratory data). The 
investigator is responsible for verifying that data entries are accurate and correct by 
physically or electronically signing the CRF. 
• 
The investigator must maintain accurate documentation (source data) that supports the 
information entered in the CRF. 
• 
The investigator must permit study-related monitoring, audits, IRB/IEC review, and 
regulatory agency inspections and provide direct access to source data documents. 
• 
Monitoring details describing strategy (e.g., risk-based initiatives in operations and 
quality such as Risk Management and Mitigation Strategies and Analytical Risk-Based 
Monitoring), methods, responsibilities and requirements, including handling of 
noncompliance issues and monitoring techniques (central, remote, or on-site 
monitoring) are provided in the Monitoring Plan. 
• 
The sponsor or designee is responsible for the data management of this study including 
quality checking of the data. 
• 
The sponsor assumes accountability for actions delegated to other individuals (e.g., 
Contract Research Organizations). 
• 
Study monitors will perform ongoing source data verification to confirm that data 
entered into the CRF by authorized site personnel are accurate, complete, and verifiable 
from source documents; that the safety and rights of participants are being protected; 
and that the study is being conducted in accordance with the currently approved 
protocol and any other study agreements, ICH GCP, and all applicable regulatory 
requirements. 
• 
Records and documents, including signed ICFs, pertaining to the conduct of this study 
must be retained by the investigator for 2 years after study completion unless local 
regulations or institutional policies require a longer retention period. No records may be 
destroyed during the retention period without the written approval of the sponsor. No 


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records may be transferred to another location or party without written notification to 
the sponsor. 
10.1.7. 
Source Documents 
• 
Source documents provide evidence for the existence of the participant and substantiate 
the integrity of the data collected. Source documents are filed at the investigator’s site. 
• 
Data reported on the CRF or entered in the eCRF that are transcribed from source 
documents must be consistent with the source documents or the discrepancies must be 
explained. The investigator may need to request previous medical records or transfer 
records, depending on the study. Also, current medical records must be available. 
• 
Data for this trial will be primarily collected in a web-based electronic data capture 
(EDC) REDCap platform.  The EDC access will be supplied by the sponsor with 
relevant training support to sites.  Sites will be responsible for training study subjects in 
the EDC system. All data specified should be captured by the site personnel or 
participants in the EDC system.  When possible, all eCRFs are to be completely filled 
out by personnel administering the study procedures in real-time at the time of the visit.  
All eCRFs that are completed in real-time at the time of the visit will be considered 
source documentation for this study. When allowed by the site’s IRB, any data entered 
on an eCRF which was not entered into REDCap in real-time at the time of the visit, or 
where such data originated from an external paper source document (e.g., signed 
Informed Consent Form (ICF) signature page, laboratory, procedure findings, etc.), will 
require paper source documents to be uploaded into the REDCap system to allow for 
source data verification monitoring.  When a site’s IRB does not allow for specific 
paper source documents to be uploaded into REDCap (e.g., the ICF signature pages, 
etc.), then those paper source documents will be reviewed during on-site monitor visits. 
• 
It is the investigator’s responsibility for the collection and reporting of all clinical, 
safety, and laboratory data entered on the CRF and confirmation the data is accurate, 
authentic, attributable, complete, and consistent.  The investigator or sub-investigator 
must sign the CRFs within the EDC system to attest the information contained with the 
CRF is true and causality of any safety information has been assessed.  All data must be 
reviewed and signed by the investigator or sub-investigator at the conclusion of the 
study for each subject.  The CRFs should not be made available in any form to third 
parties, without written permission from the sponsor. 


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10.1.8. 
Study and Site Start and Closure 
The study start date is the date on which the clinical study will be open for recruitment of 
participants. The first act of recruitment is the first site open and will be the study start date. 
 
The sponsor designee reserves the right to close the study site or terminate the study at any time 
for any reason at the sole discretion of the sponsor. Study sites will be closed upon study 
completion. A study site is considered closed when all required documents and study supplies 
have been collected and a study-site closure visit has been performed. 
The investigator may initiate study-site closure at any time, provided there is reasonable cause 
and sufficient notice is given in advance of the intended termination. 
Reasons for the early closure of a study site by the sponsor or investigator may include but are 
not limited to: 
• 
Failure of the investigator to comply with the protocol, the requirements of the IRB/IEC 
or local health authorities, the sponsor's procedures, or GCP guidelines 
• 
Inadequate recruitment of participants by the investigator 
• 
Discontinuation of further study intervention development 
 
If the study is prematurely terminated or suspended, the sponsor shall promptly inform the 
Investigators, the IECs/IRBs, the regulatory authorities, and any contract research 
organization(s) used in the study of the reason for termination or suspension, as specified by the 
applicable regulatory requirements. The Investigator shall promptly inform the participant and 
should assure appropriate participant therapy and/or follow-up 
10.1.9. 
Publication Policy 
• 
The results of this study may be published or presented at scientific meetings. If this is 
foreseen, the investigator agrees to submit all manuscripts or abstracts to Teva 
(financial sponsor) before submission. This allows the financial sponsor to protect 
proprietary information and to provide comments. 
• 
Teva (financial sponsor) will comply with the requirements for publication of study 
results. In accordance with standard editorial and ethical practice, the financial sponsor 
will generally support publication of multicenter studies only in their entirety and not as 
individual site data. In this case, a coordinating investigator will be designated by 
mutual agreement. 
• 
Authorship will be determined by mutual agreement and in line with International 
Committee of Medical Journal Editors authorship requirements. 
 


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10.2. 
Appendix 2: Clinical Laboratory Tests 
 
• 
The tests detailed in Table 1 will be performed by the local laboratory. 
• 
Protocol-specific requirements for inclusion or exclusion of participants are detailed in 
Section 5 of the protocol. 
• 
Additional tests may be performed at any time during the study as determined necessary 
by the investigator or required by local regulations. 
• 
Urine Pregnancy Testing  
Table 1: Protocol-Required Safety Laboratory Assessments 
Laboratory 
Assessments 
Parameters 
Hematology 
Platelet Count  
RBC Indices: 
MCV 
MCH 
%Reticulocytes 
White blood cell (WBC) 
count with Differential: 
Neutrophils 
Lymphocytes 
Monocytes 
Eosinophils 
Basophils 
Red blood cell (RBC) Count 
Hemoglobin 
Hematocrit 
Clinical 
Chemistry1 
Blood urea nitrogen 
(BUN) 
Potassium 
Aspartate 
Aminotransferase 
(AST)/ Serum 
Glutamic-
Oxaloacetic 
Transaminase 
(SGOT) 
Total and direct 
bilirubin 
 
Creatinine 
Sodium 
Alanine 
Aminotransferase 
(ALT)/ Serum 
Glutamic-Pyruvic 
Transaminase 
(SGPT) 
Total Protein 
 
Glucose (nonfasting) 
Calcium 
Alkaline phosphatase 
 
Other Screening 
Tests 
 
The results of each test must be entered into the CRF. 
 
Investigators must document their review of each laboratory safety report. 
 


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10.3. 
Appendix 3: Adverse Events: Definitions and Procedures for 
Recording, Evaluating, Follow-up, and Reporting 
10.3.1. 
Definition of AE 
AE Definition 
• An AE is any untoward medical occurrence in a patient or clinical study participant, 
temporally associated with the use of study intervention, whether or not considered 
related to the study intervention. 
• NOTE: An AE can therefore be any unfavorable and unintended sign (including an 
abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally 
associated with the use of study intervention. 
 
Events Meeting the AE Definition 
• Any abnormal laboratory test results (hematology, clinical chemistry, or urinalysis) or 
other safety assessments (e.g., ECG, radiological scans, vital signs measurements), 
including those that worsen from baseline, considered clinically significant in the 
medical and scientific judgment of the investigator (i.e., not related to progression of 
underlying disease). 
• Exacerbation of a chronic or intermittent pre-existing condition including either an 
increase in frequency and/or intensity of the condition. 
• New conditions detected or diagnosed after study intervention administration even 
though it may have been present before the start of the study. 
• Signs, symptoms, or the clinical sequelae of a suspected drug-drug interaction. 
• Signs, symptoms, or the clinical sequelae of a suspected overdose of either study 
intervention or a concomitant medication. Overdose per se will not be reported as an 
AE/SAE unless it is an intentional overdose taken with possible suicidal/self-harming 
intent. Such overdoses should be reported regardless of sequelae. 
• The signs, symptoms, and/or clinical sequelae resulting from lack of efficacy will be 
reported as AE or SAE if they fulfil the definition of an AE or SAE. Also, “lack of 
efficacy” or “failure of expected pharmacological action” also constitutes an AE or 
SAE. 
 
 
 


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Events NOT Meeting the AE Definition 
• Any clinically significant abnormal laboratory findings or other abnormal safety 
assessments which are associated with the underlying disease, unless judged by the 
investigator to be more severe than expected for the participant’s condition. 
• The disease/disorder being studied or expected progression, signs, or symptoms of the 
disease/disorder being studied, unless more severe than expected for the participant’s 
condition. 
• Medical or surgical procedure (e.g., endoscopy, appendectomy): the condition that 
leads to the procedure is the AE. 
• Situations in which an untoward medical occurrence did not occur (social and/or 
convenience admission to a hospital). 
• Anticipated day-to-day fluctuations of pre-existing disease(s) or condition(s) present or 
detected at the start of the study that do not worsen. 
10.3.2. 
Definition of SAE 
If an event is not an AE per definition above, then it cannot be an SAE even if serious conditions 
are met (e.g., hospitalization for signs/symptoms of the disease under study, death due to 
progression of disease). 
A SAE is defined as any untoward medical occurrence that, at any dose: 
a. Results in death 
b. Is life-threatening 
The term 'life-threatening' in the definition of 'serious' refers to an event in which the 
participant was at risk of death at the time of the event. It does not refer to an event, which 
hypothetically might have caused death, if it were more severe. 
c. 
Requires inpatient hospitalization or prolongation of existing hospitalization 
• In general, hospitalization signifies that the participant has been detained (usually 
involving at least an overnight stay) at the hospital or emergency ward for observation 
and/or treatment that would not have been appropriate in the physician’s office or 
outpatient setting. Complications that occur during hospitalization are AEs. If a 
complication prolongs hospitalization or fulfills any other serious criteria, the event is 
serious. When in doubt as to whether “hospitalization” occurred or was necessary, the 
AE should be considered serious. 


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A SAE is defined as any untoward medical occurrence that, at any dose: 
• Hospitalization for elective treatment of a pre-existing condition that did not worsen 
from baseline is not considered an AE. 
d. Results in persistent disability/incapacity 
• The term disability means a substantial disruption of a person’s ability to conduct 
normal life functions. 
• This definition is not intended to include experiences of relatively minor medical 
significance such as uncomplicated headache, nausea, vomiting, diarrhea, influenza, 
and accidental trauma (e.g., sprained ankle) which may interfere with or prevent 
everyday life functions but do not constitute a substantial disruption. 
e. 
Is a congenital anomaly/birth defect 
f. 
Other situations: 
• Medical or scientific judgment should be exercised in deciding whether SAE reporting 
is appropriate in other situations such as important medical events that may not be 
immediately life-threatening or result in death or hospitalization but may jeopardize the 
participant or may require medical or surgical intervention to prevent one of the other 
outcomes listed in the above definition. These events should usually be considered 
serious. 
• 
Examples of such events include invasive or malignant cancers, intensive treatment in 
an emergency room or at home for allergic bronchospasm, blood dyscrasias or 
convulsions that do not result in hospitalization, or development of drug dependency or 
drug abuse. 
10.3.3. 
Recording and Follow-Up of AE and/or SAE 
AE and SAE Recording 
• When an AE/SAE occurs, it is the responsibility of the investigator to review all 
documentation (e.g., hospital progress notes, laboratory reports, and diagnostics 
reports) related to the event. 
• The investigator will then record all relevant AE/SAE information in the CRF. 
• It is not acceptable for the investigator to send photocopies of the participant’s medical 
records in lieu of completion of the AE/SAE CRF page. 


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AE and SAE Recording 
• There may be instances when copies of medical records for certain cases are requested. 
In this case, all participant identifiers, with the exception of the participant number, 
will be redacted on the copies of the medical records before submission. 
• The investigator will attempt to establish a diagnosis of the event based on signs, 
symptoms, and/or other clinical information. Whenever possible, the diagnosis (not the 
individual signs/symptoms) will be documented as the AE/SAE. 
Assessment of Intensity 
The investigator will make an assessment of intensity for each AE and SAE reported during 
the study and assign it to 1 of the following categories:  
• Mild: An event that is easily tolerated by the participant, causing minimal discomfort 
and not interfering with everyday activities. 
• Moderate: An event that causes sufficient discomfort and interferes with normal 
everyday activities. 
• Severe: An event that prevents normal everyday activities. An AE that is assessed as 
severe should not be confused with a SAE. Severe is a category utilized for rating the 
intensity of an event; and both AEs and SAEs can be assessed as severe. 
An event is defined as ‘serious’ when it meets at least 1 of the predefined outcomes as 
described in the definition of an SAE, NOT when it is rated as severe. 
 
Assessment of Causality 
• The investigator is obligated to assess the relationship between study intervention and 
each occurrence of each AE/SAE. 
• A “reasonable possibility” of a relationship conveys that there are facts, evidence, 
and/or arguments to suggest a causal relationship, rather than a relationship cannot be 
ruled out. 
• The investigator will use clinical judgment to determine the relationship. 
• Alternative causes, such as underlying disease(s), concomitant therapy, and other risk 
factors, as well as the temporal relationship of the event to study intervention 
administration will be considered and investigated. 
• The investigator will also consult the Investigator’s Brochure (IB) and/or Product 
Information, for marketed products, in his/her assessment. 
• For each AE/SAE, the investigator must document in the medical notes that he/she has 
reviewed the AE/SAE and has provided an assessment of causality. 


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Assessment of Causality 
• There may be situations in which an SAE has occurred and the investigator has 
minimal information to include in the initial report. However, it is very important that 
the investigator always make an assessment of causality for every event before the 
initial transmission of the SAE data. 
• The investigator may change his/her opinion of causality in light of follow-up 
information and send a SAE follow-up report with the updated causality assessment. 
• The causality assessment is one of the criteria used when determining regulatory 
reporting requirements. 
 
Follow-up of AEs and SAEs 
• The investigator is obligated to perform or arrange for the conduct of supplemental 
measurements and/or evaluations as medically indicated or as requested to elucidate 
the nature and/or causality of the AE or SAE as fully as possible. This may include 
additional laboratory tests or investigations, histopathological examinations, or 
consultation with other health care professionals. 
• New or updated information will be recorded in the originally completed CRF. 
• The investigator will submit any updated SAE data within 24 hours of receipt of the 
information. 
10.3.4. 
Reporting of SAEs 
SAE Reporting to Sponsor and Medical Monitor via an Electronic Data Collection Tool 
• The primary mechanism for reporting an SAE to sponsor and medical monitor will be 
the electronic data collection tool. 
• If the electronic system is unavailable, then the site will use the paper SAE data 
collection tool (see next section) in order to report the event within 24 hours. 
• The site will enter the SAE data into the electronic system as soon as it becomes 
available. 
• After the study is completed at a given site, the electronic data collection tool will be 
taken off-line to prevent the entry of new data or changes to existing data. 
• If a site receives a report of a new SAE from a study participant or receives updated 
data on a previously reported SAE after the electronic data collection tool has been 
taken off-line, then the site can report this information on a paper SAE form (see next 
section) or to the sponsor and medical monitor by telephone. 


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SAE Reporting to Sponsor and Medical Monitor via an Electronic Data Collection Tool 
• Contacts for SAE reporting can be found in the investigative site file. 
 
SAE Reporting to Sponsor and Medical Monitor via Paper CRF 
• Facsimile transmission of the SAE paper CRF is the preferred method to transmit this 
information to the sponsor and medical monitor. 
• In rare circumstances and in the absence of facsimile equipment, notification by 
telephone is acceptable with a copy of the SAE data collection tool sent by overnight 
mail or courier service. 
• Initial notification via telephone does not replace the need for the investigator to 
complete and sign the SAE CRF pages within the designated reporting time frames. 
• Contacts for SAE reporting can be found in the investigative site file. 
 
 
 
 


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10.4. 
Appendix 4: Contraceptive Guidance and Collection of Pregnancy 
Information 
Definitions: 
 
Definitions of Woman of Childbearing Potential (WOCBP), sterile and postmenopausal women, 
male contraception, and highly effective and acceptable birth control methods are to be 
determined based on investigator’s judgment; however, women in the following categories are 
not considered WOCBP 
1. Premenarchal 
2. Premenopausal female with 1 of the following: 
• Documented hysterectomy 
• Documented bilateral salpingectomy 
• Documented bilateral oophorectomy 
 
For individuals with permanent infertility due to an alternate medical cause other than the 
above, (e.g., mullerian agenesis, androgen insensitivity), investigator discretion should be 
applied to determining study entry. 
 
Note: Documentation can come from the site personnel’s: review of the participant’s medical 
records, medical examination, or medical history interview. 
 
3. Postmenopausal female 
• A postmenopausal state is defined as no menses for 12 months without an alternative 
medical cause. 
If fertility is unclear (e.g., amenorrhea in adolescents or athletes) and a menstrual cycle 
cannot be confirmed before first dose of study intervention, additional evaluation should be 
considered. 
 
Contraception Guidance: 
Collection of Pregnancy Information 
Male participants with partners who become pregnant 


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• The investigator will attempt to collect pregnancy information on any male participant’s 
female partner who becomes pregnant while the male participant is in this study. This 
applies only to male participants who receive AJOVY® (fremanezumab-vfrm). 
• After obtaining the necessary signed informed consent from the pregnant female partner 
directly, the investigator will record pregnancy information on the appropriate form and 
submit it to the sponsor within 24 hours of learning of the partner’s pregnancy. The 
female partner will also be followed to determine the outcome of the pregnancy. 
Information on the status of the mother and child will be forwarded to the sponsor. 
Generally, the follow-up will be no longer than 6 to 8 weeks following the estimated 
delivery date. Any termination of the pregnancy will be reported regardless of fetal status 
(presence or absence of anomalies) or indication for the procedure.  
Female Participants who become pregnant 
• 
The investigator will collect pregnancy information on any female participant who 
becomes pregnant while participating in this study. The initial information will be 
recorded on the appropriate form and submitted to the sponsor within 24 hours of 
learning of a participant's pregnancy.  
• 
The participant will be followed to determine the outcome of the pregnancy. The 
investigator will collect follow-up information on the participant and the neonate and the 
information will be forwarded to the sponsor. Generally, follow-up will not be required 
for longer than 6 to 8 weeks beyond the estimated delivery date. Any termination of 
pregnancy will be reported, regardless of fetal status (presence or absence of anomalies) 
or indication for the procedure. 
• 
While pregnancy itself is not considered to be an AE or SAE, any pregnancy 
complication or elective termination of a pregnancy for medical reasons will be reported 
as an AE or SAE.  
• 
A spontaneous abortion (occurring at <22 weeks gestational age) or still birth (occurring 
at >22 weeks gestational age) is always considered to be an SAE and will be reported as 
such.  
• 
Any post-study pregnancy related SAE considered reasonably related to the study 
intervention by the investigator will be reported to the sponsor as described in Section 
8.3.4. While the investigator is not obligated to actively seek this information in former 
study participants, he or she may learn of an SAE through spontaneous reporting. 
Any female participant who becomes pregnant while participating in the study will discontinue 
study intervention or be withdrawn from the study.  


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10.5. 
Appendix 5: International Classification of Headache Disorders, 3rd 
edition: Migraine with and without aura 
 
1.1 Migraine without aura 
Description: Recurrent headache disorder manifesting in attacks lasting 4–72 hours Typical 
characteristics of the headache are unilateral location, pulsating quality, moderate or severe 
intensity, aggravation by routine physical activity and association with nausea and/or 
photophobia and phonophobia. 
 
Diagnostic criteria: 
A. At least five attacks fulfilling criteria B–D 
B. Headache attacks lasting 4–72 hours (when untreated or unsuccessfully treated) 
C. Headache has at least two of the following four characteristics: 
1. unilateral location 
2. pulsating quality 
3. moderate or severe pain intensity 
4. aggravation by or causing avoidance of routine physical activity (e.g. walking or 
climbing stairs) 
D. During headache at least one of the following: 
1. nausea and/or vomiting 
2. photophobia and phonophobia 
E. Not better accounted for by another ICHD-3 diagnosis. 
 
 


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1.2 Migraine with aura 
 
Description: Recurrent attacks, lasting minutes, of unilateral fully reversible visual, sensory or 
other central nervous system symptoms that usually develop gradually and are usually followed 
by headache and associated migraine symptoms. 
 
Diagnostic criteria: 
 
A. At least two attacks fulfilling criteria B and C 
B. One or more of the following fully reversible aura symptoms: 
1. visual 
2. sensory 
3. speech and/or language 
4. motor 
5. brainstem 
6. retinal 
C. At least three of the following six characteristics: 
1. at least one aura symptom spreads gradually over ≥5 minutes 
2. two or more aura symptoms occur in succession 
3. each individual aura symptom lasts 5–60 minutes 
4. at least one aura symptom is unilateral 
5. at least one aura symptom is positive 
6. the aura is accompanied, or followed within 60 minutes, by headache 
D. Not better accounted for by another ICHD-3 diagnosis. 
 


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10.6. 
Appendix 6: Abbreviations 
 
Abbreviation or Term 
Definition/Explanation 
AE 
Adverse Event 
ANOVA 
Analysis of variance 
BMWS 
Brief Measure of Worry Severity 
CFR 
Code of Federal Regulations 
CGRP 
Calcitonin gene-related peptide 
CIOMS 
Council for International Organizations of Medical Sciences 
CMP 
Comprehensive metabolic panel 
CONSORT 
Consolidated Standards of Reporting Trials 
CRF 
Case report form 
CRO 
Contract Research Organization 
DHD 
Daily headache diary 
DMC 
Data Monitoring Committee 
ECG 
Electrocardiography 
EDC 
Electronic Data Capture 
GCP 
Good Clinical Practice 
GSE-SF 
General Self-Efficacy Short Form 
HIPAA 
Health Insurance Portability and Accountability Act 
ICF 
Informed consent form 
ICH 
International Council for Harmonisation of Technical Requirements 
for Pharmaceuticals for Human Use 


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ICHD-III 
International Classification of Headache Disorders 3rd edition 
IEC 
Independent Ethics Committee(s) 
IRB 
Institutional Review Board(s) 
LOCF 
Last observation carried forward 
MIBS-4 
Migraine Interictal Burden Scale 
MOH 
Medication Overuse Headache 
MP 
Monitoring Plan 
PHQ-9 
9-Item Depression Patient Health Questionnaire 
SAE 
Serious Adverse Event 
SAP 
Statistical analysis plan 
SDSF 
Neuro-QoL Sleep Disturbance Short Form 
SoA 
Schedule of Activities 
SUSAR 
Suspected unexpected serious adverse reactions 
WOCBP 
Women of Childbearing Potential 
WPAI-M 
Work Productivity and Activity Impairment- Migraine 


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Page 50 of 50 
 
11. 
References 
 
1. Peres, M. F. P., Mercante, J. P. P., Guendler, V. Z., Corchs, F., Bernik, M. A., Zukerman, E., 
& Silberstein, S. D. (2007). Cephalalgiaphobia: a possible specific phobia of illness. The 
Journal of Headache and Pain, 8, 56-59. https://doi.org/10.1007/s10194-007-0361-3 
2. Mannix, S., Skalicky, A., Buse, D. C., Desai, P., Sapra, S. Ortmeier, B., . . . Hareendran, A. 
(2016). Measuring the impact of migraine for evaluating outcomes of preventive treatments 
for migraine headaches.  Health and Quality of Life Outcomes, 14(143). 
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3. Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical 
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