Migraine With and Without Aura Response to Remote Electrical Neuromodulation (REN) Treatment

Study Overview
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Brief Summary
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This is a Post-marketing study investigating the safety and efficacy of the acute treatment of migraine with a Remote Electrical Neuromodulation (REN) device (Nerivio) in migraine patients with and without aura, as well as characterizing demographic and attack characteristic differences between migraine patients with and without aura. Safety will be assessed by the number and type of device-related adverse events. Efficacy will be evaluated as a change in headache pain severity from baseline to 2 hours post-treatment. Disease characteristics will look into demographic and attack differences between patients with and without aura.

Detailed Description
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The REN device (Nerivio by Theranica, ISRAEL) is a neuromodulation device approved by the FDA for acute and/or preventive treatment of migraine in patients 12 years old and above. It is a wearable device applied to the upper arm. It stimulates C and Aδ noxious fibers using a modulated, symmetrical, biphasic, square pulse with a pulse width of 400 μs, modulated frequency of 100-120 Hz, and up to 40 mA output current which the patient can adjust. The REN device is operated by a designated smartphone application that is downloaded to the user's phone prior first use of the Nerivio device. As part of the sign-up process for the Nerivio app, all patients accept the terms of use which specify that providing personal information is done on their own free will and that their de-identified data may be used for research purposes. Users are not obligated to provide personal information and could treat without providing any feedback. The app includes a secured, personal migraine diary, which enables patients to record and track their migraines and other headaches. At the beginning of each treatment, and again 2 hours after the start of treatment, patients are prompted to record their symptoms, including the presence or absence of aura, pain level (none, mild, moderate, severe), functional disability (none, mild limitation, moderate limitation, severe limitation), presence of associated symptoms (photophobia, phonophobia, and nausea), and an indication of which medications, if any, were taken within that 2-hour time window. Post-marketing surveillance is designed to assess the safety and efficacy of REN in larger and more diverse populations than in clinical trials and in various real-world environments and situations. As a digital therapeutic device (i.e., electroceutical), the REN device enables prospective collection of electronic patient-reported outcomes in real-world clinical practice. This post-marketing RWE study investigates the safety and efficacy of the Nerivio treatment in patients with and without aura by analyzing data from patients who used the Nerivio device. The following outcomes will be assessed: - Safety - all adverse events that were reported during the study's period - Efficacy - pain relief, freedom from pain, improvement in functional disability, and return to normal function (no disability) at 2 hours post-treatment 3 - Disease severity -severe headache pain, presence of associated symptoms. Together, these objectives provide a comprehensive evaluation of the effect of REN as a treatment for migraine with or without aura.

Official Title
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Comparison of Migraine With and Without Aura in a Large Cohort: Disease Characteristics and Response to Remote Electrical Neuromodulation (REN) Treatment

Conditions
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Migraine With Aura, Migraine Without Aura

Intervention / Treatment
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* Device: Nerivio device


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 12 years old and above REN users across the USA who created Nerivio accounts between October 2019 and February 2023. Treated acute migraine at least once with Nerivio device Reported at least one treatment questionnaire at T=0h and T=2h Exclusion Criteria: Treatments shorter than 30 minutes

Ages Eligible for Study
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Minimum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Migraine with aura (MWA)<br>Patients with migraine who used the Nerivio device at least once and reported having aura in at least one treatment | Device: Nerivio device<br>* REN treatment with Nerivio device<br>|
| Migraine without aura (MWoA )<br>Patients with migraine who used the Nerivio device at least once and never reported having aura in any of their treatments | Device: Nerivio device<br>* REN treatment with Nerivio device<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Consistent Headache Relief at 2 Hours Post-treatment | The proportion of subjects reporting headache relief at 2 hours post-treatment in at least 50% of all their treatments. Headache relief is defined as an improvement from severe or moderate pain to mild or no pain. | 2 hours | 
| Device Related Adverse Events | Incidence of device-related adverse events reported by subjects | 40 Months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Consistent Freedom From Headache at 2 Hours Post-treatment | The proportion of subjects reporting freedom from headache at 2 hours post-treatment in at least 50% of all their treatments. Pain freedom is defined as the disappearance of headache from severe, moderate, or mild headache at treatment initiation to no headache 2 hours later | 2 hours | 
| Severe Headache Pain during migraine attack | The proportion of subjects reporting severe headache pain in at least 50% of their attacks. | 2 hours | 
| Associated Symptoms Relief | The proportion of subjects reporting each of the migraine-associated symptoms (photophobia, phonophobia, nausea) in at least 50% of their attacks. | 2 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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migraine, Nerivio, REN