Paul Durham, PhD

“One of the things that we talk about is whether or not to use it as adjunctive therapy, so to use the triptan, and then follow it up with nVNS. If they really are truly working through different pathways, it might be a good idea to use combination therapy. We’ve done it with a triptan and an NSAID, and we’ve seen it work better in some patients.”

Noninvasive vagus nerve stimulation (nVNS) was approved by the FDA in January 2018, based on data which showed consistent and significantly better pain relief at both 30 and 60 minutes (

 <.03), and a decrease of pain intensity at 30, 60, and 90 minutes, and reduction in rescue medicine.

 Since, further study of the method has come to uncover that it may be operating under a novel mechanism of action.

Due to this, its potential for use in headache medicine has grown. This suggests not only that it could be used alone or in combination with acute medications, such as triptans, but that it may offer an option for a number of other pain conditions.

2019 American Headache Society Annual Meeting

, July 11-14, in Philadelphia, Pennsylvania, Paul Durham, PhD, distinguished professor and director of cell biology, Missouri State University, to discuss this within the context of recent findings of his and his team’s. This data suggested that the pathway might be novel, and that nVNS could be as effective alone as triptan therapy in the relief of episodic migraine.

1. Tassorelli C, Grazzi L, de Tommaso M, et al; PRESTO Study Group. Noninvasive vagus nerve stimulation as acute therapy for migraine: the randomized PRESTO study. 

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

Videos

The distinguished professor and director of cell biology at Missouri State University discussed the use of nVNS in migraine treatment and whether or not it can replace the use of or be used in conjunction with triptans&mdash;a medication on which many patients fail or report poor response on.

Paul Durham, PhD: A Combination Approach With nVNS in Migraine

“What we found is that when we put inhibitors of the serotonin receptors, the 5HT

, that we could basically block the inhibitory effect of the vagus nerve, which actually then provides evidence that this is a completely novel mechanism. It’s different than a lot of the anti-migraine drugs that are currently on the market.”

, July 11-14, in Philadelphia, Pennsylvania, Paul Durham, PhD, and colleagues presented data showing that noninvasive vagus nerve stimulation could be as effective as triptan therapy in the relief of episodic migraine. However, the work also identified that this method of stimulation may be working through a novel mechanism of action.

 sat with Durham to find out more about the study’s findings and how this intervention differs from what’s currently available to patients. He explained that the team injected complete Freund’s adjuvant (CFA) at 10 rat neck muscle sites to induce inflammation in the model, and then exposed them to either the aroma of California bay leaf oil extract or sodium nitroprusside. Either stimulation administered in 1 ms pulses at 5 kHz, repeated at 25 Hz for 2 minutes at a pair of 5-minute intervals, or sumatriptan delivered subcutaneously at a dose of 0.3 mg/kg.

Noninvasive vagus nerve stimulation was approved by the FDA in January 2018, based on data from the PRESTO trial (NCT02686034), which showed consistent and significantly better pain relief at both 30 and 60 minutes (

 <.03). Additionally, it showed a decrease of pain intensity at 30, 60, and 90 minutes, as well as a reduction in rescue medicine.

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

2. Tassorelli C, Grazzi L, de Tommaso M, et al; PRESTO Study Group. Noninvasive vagus nerve stimulation as acute therapy for migraine: the randomized PRESTO study. 

The distinguished professor and director of cell biology at Missouri State University discussed the findings of a model of nVNS which suggested it operates through a novel mechanism compared to available migraine therapies.

Paul Durham, PhD

Articles

Paul Durham, PhD: A Combination Approach With nVNS in Migraine

Paul Durham, PhD: Noninvasive Vagus Nerve Stimulation