A growing body of literature on the cosmetic use of OnabotulinumtoxinA has suggested that the use of preserved saline exerts a local anesthetic effect, and reduces the procedure discomfort when used in reconstitution in lieu of preservative-free saline. However, this has never been studied in chronic migraine. While reducing discomfort is a desirable target in all procedures, it has a special importance in the use of OnabotulinumtoxinA for chronic migraine due to the numerous injection locations each session (31 sites) and the ubiquity of scalp tenderness in this population. In addition, the pain during procedure is a known migraine trigger for many of these patients. We hypothesize that preserved saline (known as bacteriostatic saline) produces lower procedure-related discomfort when used as a dissolving solution for OnabotulinumtoxinA in individuals with chronic migraine as opposed to using preservative-free saline. In addition, we hypothesize that reduction of procedure-relate pain during the injections will also result in reduced migraine/headache attacks in the week immediately following the procedure.
Full Title of Study: “Onabotulinumtoxin Type A Reconstitution With Preserved Versus Preservative-free Saline in Chronic Migraine. A Randomized, Double-blind Trial.”
- Study Type: Interventional
- Study Design
- Allocation: Randomized
- Intervention Model: Parallel Assignment
- Primary Purpose: Treatment
- Masking: Triple (Participant, Care Provider, Investigator)
- Study Primary Completion Date: June 1, 2019
- Other: Preserved saline in reconstitution of Botox
- The intervention consists of using 4 ml of preserved saline for the reconstitution of OnabotuliniumtoxinA prior to its use in subjects with chronic migraine.
Arms, Groups and Cohorts
- No Intervention: Botox in preservative-free saline
- OnabotulinumtoxinA (Botox) 200u will be reconstituited using 4 ml of preservative-free saline, as recommended by the manufacturer. 155-195 u of Onabotulinumtoxin A (Botox) will be injected in subjects with chronic migraine, consistent with FDA-approval indications, following the standard injection protocol (31 sites)
- Active Comparator: Botox in preserved saline
- OnabotulinumtoxinA (Botox) 200u will be reconstituited using 4 ml of preservative saline (i.e. bacteriostatic saline). 155-195 u of Onabotulinumtoxin A (Botox) will be injected in subjects with chronic migraine, consistent with FDA-approval indications, following the standard injection protocol (31 sites).
Clinical Trial Outcome Measures
- Verbal Pain Scale
- Time Frame: Immediately after intervention
- Difference in verbal pain scale (0 to 10, 0 indicates no pain, and 10 indicates most severe pain)
- Headache-day frequency
- Time Frame: 1 week
- Difference in headache-days in the first week following the procedure
Participating in This Clinical Trial
- Patients with diagnosis of chronic migraine receiving FDA-approved treatment with OnabotulinumtoxinA injection as per standard protocol. Standard protocol consists of 31 injection sites, with total dose ranging from 155 u to 195u. Exclusion Criteria:
- Subjects whom OnabotulinumtoxinA injections deviate from standard protocol for any reason, such as head/neck infection, head deformity, recent surgery…etc.
Gender Eligibility: All
Minimum Age: 18 Years
Maximum Age: 79 Years
Are Healthy Volunteers Accepted: No
- Lead Sponsor
- State University of New York – Upstate Medical University
- Provider of Information About this Clinical Study
- Principal Investigator: Awss Zidan, MD, Clinical Instructor – State University of New York – Upstate Medical University
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