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


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—a medication on which many patients fail or report poor response on.

“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 (P <.03), and a decrease of pain intensity at 30, 60, and 90 minutes, and reduction in rescue medicine.1 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.

At the 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.2

For more coverage of AHS 2019, click here.


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. Neurology. 2018;91:e364-e373.

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.

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