Medical Therapies for Chronic Post-Traumatic Headaches

Overview

To determine if propranolol, amitriptyline, or topiramate decreases headache frequency in patients with chronic post-traumatic headaches.

Full Title of Study: “A Randomized Controlled Trial of Medical Therapies for Chronic Post-Traumatic Headaches”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Factorial Assignment
    • Primary Purpose: Treatment
    • Masking: Triple (Participant, Care Provider, Investigator)
  • Study Primary Completion Date: April 2013

Detailed Description

A total of 240 patients meeting International Classification of Headache Disorders (ICHD) diagnostic criteria for chronic post-traumatic headaches will be enrolled. Subjects will be recruited from the Neurology Clinic at Madigan Army Medical Center. Study participants will be U.S. Army soldiers who sustained a mild traumatic head injury while deployed to a combat theater resulting in chronic post-traumatic headaches. Subjects will be randomized to placebo, propranolol (target dose 80 mg a day), amitriptyline (target dose 50 mg a day), or topiramate (target dose 100 mg a day) for 3 months. The primary outcome measure will be the mean number of headache days per month on the third month of treatment. Secondary outcome measures will include the proportion of subjects with at least a 25% reduction in headache frequency, headache severity (0-10 scale), headache duration (hours), headache-related disability (measured by the Headache Impact Test and Migraine Disability Assessment Scale), PTSD symptom checklist score, and medication side effects and tolerability.

Interventions

  • Drug: Placebo
    • Every month for 3 months
  • Drug: Propranolol
    • target does 80 mg per day for 3 months
  • Drug: Amitriptyline
    • Target does of 50 mg per day for 3 months
  • Drug: Topiramate
    • Target dose 100 mg a day for 3 months

Arms, Groups and Cohorts

  • Placebo Comparator: Placebo
    • Placebo group
  • Experimental: Propranolol
    • Propranolol (target dose 80 mg a day)
  • Experimental: Topiramate
    • Topiramate (target dose 100 mg a day)
  • Experimental: Amitriptyline
    • Amitriptyline (target dose 50 mg a day)

Clinical Trial Outcome Measures

Primary Measures

  • Headache days per month on the third month of treatment
    • Time Frame: Monthly for 4 weeks

Participating in This Clinical Trial

Inclusion Criteria

1. Patient meets ICHD criteria for chronic post-traumatic headaches (see below). 2. Patient is 18-50 years old. 3. Patient has experienced 6 or more days of headache per month for each of the last 2 months. 4. Patient has full capacity to provide informed consent. 5. Patient will be available for all study-related visits over the next 4 months. 6. Patient must be eligible to receive care at Madigan Army Medical Center International Classification of Headache Disorders (version 2) diagnostic criteria for chronic post-traumatic headaches attributed to mild head injury: 1. Headaches beginning within 1 week of mild traumatic head injury. 2. Headaches persisting > 3 months after head trauma. 3. Head trauma with all of the following:

  • no loss of consciousness or loss of consciousness < 30 minutes – Glasgow Coma Score (GCS) 13-15 – symptoms or signs diagnostic of concussion Exclusion criteria:

1. Patient has another headache disorder not attributable to head trauma which accounts for at least half of the patient's headache episodes. 2. Patient is currently taking propranolol, amitriptyline, or topiramate for any reason. 3. Patient previously tried propranolol, amitriptyline, or topiramate for headache treatment. 4. Patient started a new treatment for headache prevention within the last 6 weeks. Prophylactic treatments initiated prior to 6 weeks ago are allowed as long as the dose or regimen is stable. Medications for aborting acute headaches are also allowed. 5. Patient previously tried more than two medications for headache prevention. 6. Patient is using narcotic analgesics on average more than 10 days a month. 7. Patient has a medical condition or is taking a medication that is considered a contraindication for propranolol, topiramate, or amitriptyline. Medical conditions include liver disease, renal impairment, cardiac dysrhythmias, untreated thyroid disease, orthostatic hypotension, asthma requiring treatment with inhalers, glaucoma, kidney stones, insulin-requiring diabetes, or pregnancy. 8. Patient has known hepatic, renal, or cardiac disorders. 9. Patient drinks on average more than two servings of alcohol (2 oz hard liquor, 5 oz wine, 12 oz beer) per day or more than 3 servings at one time on a weekly basis. 10. Patient has abnormalities on baseline EKG. 11. Patient has major depression defined as a score >15 on the Patient Health Questionnaire-9. 12. Patient is pregnant, planning to become pregnant in the next year, or is a female of reproductive potential who is not using a reliable form of birth control. 13. Patient has cognitive impairment defined as mini-mental status exam score <27. 14. SBP < 90, HR < 50, or HR > 100.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 50 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Madigan Army Medical Center
  • Collaborator
    • U.S. Army Medical Research and Development Command
  • Provider of Information About this Clinical Study
    • Principal Investigator: Jay C. Erickson, Chief, Neurology Service – Madigan Army Medical Center
  • Overall Official(s)
    • Jay Erickson, MD, Principal Investigator, Madigan Army Medical Center

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