Nerivio Efficacy by Time of Treatment Onset

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 8 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 app that is downloaded to the user's phone prior to 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 secure, personal migraine diary, which enables patients to record and track their migraines and other headaches. At the beginning of each treatment, and again at 2 hours after the start of treatment, patients are prompted to record their symptoms, including pain level (none, mild, moderate, severe), functional disability (None, Mild limitation, Moderate limitation, Severe limitation), 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, utilization, and efficacy in larger and more diverse populations 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 impact of early treatment (within 60 minutes from the migraine onset) vs. late treatment (over 60 minutes from the migraine onset) on the effectiveness of the Nerivio treatment of acute migraine.

for this study, treatments were classified as 'early treatments' if Nerivcio was administered within 1-hour (60 minutes) of migraine onset and classified as 'late treatments' if administered more than 1-hour (60 minutes) after onset. On a patient level, a patient was defined as an 'early-treater' if s/he had reported treatment onset in at least two treatments and had treated early in 50% or more of treatments. A patient was defined as a 'late-treater' if s/he had reported treatment onset in at least two treatments and had treated late in more than 50% of treatments.

The following efficacy outcome will be assessed - Pain Relief, Pain Freedom, Functional Disability Relief, Functional Disability Freedom, Freedom from each migraine-associated symptom (Photophobia, Phonophobia, Nausea/Vomiting) and Consistent Efficacy.

Inclusion criteria

• • Users who had reported treatment onset time in at least one treatment through the REN companion smartphone app

Exclusion criteria

• • Treatments that included medications for acute treatment of migraine