Acute migraine therapy with external trigeminal neurostimulation (ACME): A randomized controlled trial

Objective: To assess the safety and efficacy of external trigeminal nerve stimulation for acute pain relief during migraine attacks with or without aura via a sham-controlled trial. Methods: This was a double-blind, randomized, sham-controlled study conducted across three headache centers in the United States. Adult patients who were experiencing an acute migraine attack with or without aura were recruited on site and randomly assigned 1:1 to receive either verum or sham external trigeminal nerve stimulation treatment (CEFALY Technology) for 1 hour. Pain intensity was scored using a visual analogue scale (0 = no pain to 10 = maximum pain). The primary outcome measure was the mean change in pain intensity at 1 hour compared to baseline. Results: A total of 109 participants were screened between February 1, 2016 and March 31, 2017. Of these, 106 patients were randomized and included in the intention-to-treat analysis (verum: n = 52; sham: n = 54). The primary outcome measure was significantly more reduced in the verum group than in the sham group: −3.46 ± 2.32 versus −1.78 ± 1.89 (p < 0.0001), or −59% versus −30% (p < 0.0001). With regards to migraine subgroups, there was a significant difference in pain reduction between verum and sham for ‘migraine without aura’ attacks: mean visual analogue scale reduction at 1 hour was −3.3 ± 2.4 for the verum group versus −1.7 ± 1.9 for the sham group (p = 0.0006). For ‘migraine with aura’ attacks, pain reduction was numerically greater for verum versus sham, but did not reach significance: mean visual analogue scale reduction at 1 hour was −4.3 ± 1.8 for the verum group versus −2.6 ± 1.9 for the sham group (p = 0.060). No serious adverse events were reported and five minor adverse events occurred in the verum group. Conclusion: One-hour treatment with external trigeminal nerve stimulation resulted in significant headache pain relief compared to sham stimulation and was well tolerated, suggesting it may be a safe and effective acute treatment for migraine attacks. Study protocol: ClinicalTrials.gov Identifier: NCT02590939. © International Headache Society 2018

Mammalian mesocarnivore visitation at tortoise burrows in a wind farm

There is little information on predator–prey interactions in wind energy landscapes in North America, especially among terrestrial vertebrates. Here, we evaluated how proximity to roads and wind turbines affect mesocarnivore visitation with desert tortoises (Gopherus agassizii) and their burrows in a wind energy landscape. In 2013, we placed motion-sensor cameras facing the entrances of 46 active desert tortoise burrows in a 5.2-km2 wind energy facility near Palm Springs, California, USA. Cameras recorded images of 35 species of reptiles, mammals, and birds. Counts for 4 species of mesocarnivores at desert tortoise burrows increased closer to dirt roads, and decreased closer to wind turbines. Our results suggest that anthropogenic infrastructure associated with wind energy facilities could influence the general behavior of mammalian predators and their prey. Further investigation of proximate mechanisms that underlie road and wind turbine effects (i.e., ground vibrations, sound emission, and traffic volume) and on wind energy facility spatial designs (i.e., road and wind turbine configuration) could prove useful for better understanding wildlife responses to wind energy development. © 2017 The Wildlife Society