Paul Durham, PhD: Noninvasive Vagus Nerve Stimulation


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.

“What we found is that when we put inhibitors of the serotonin receptors, the 5HT3 or 5HT7, 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.”

At the 2019 American Headache Society Annual Meeting, 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.1

NeurologyLive 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 (P <.03). Additionally, it showed a decrease of pain intensity at 30, 60, and 90 minutes, as well as a reduction in rescue medicine.2

For more coverage of AHS 2019, click here.


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. Neurology. 2018;91:e364-e373.

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