Saline Injections for Prophylactic Treatment of Chronic Migraine

Overview

In this study, the investigators want to investigate whether saline injections in the neck and head muscles can reduce symptoms of chronic migraine. In existing studies, saline injections (used as placebo treatment) have given patients with chronic migraine an average of 7 headache-free days per month.

Full Title of Study: “Saline Injections for Prophylactic Treatment of Chronic Migraine – a Randomized Controlled Study”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Single (Participant)
  • Study Primary Completion Date: December 2022

Detailed Description

Patients who meet the diagnostic criteria for chronic migraine will be invited to participate in the study. All participants will undergo a medical examination. The participants will fill out an electronic headache diary for one month. This will give a picture of the current headache pattern and establish a baseline. The participants will then be randomized into two groups: saline injections or needle sticks without injection. They will not be aware of which group they belong to. The treatment will be repeated on two occasions three months apart. The headache diary will continue during the treatment period and up to three months after the second treatment. The effect will be analyzed by comparing baseline data from the headache diary to data after treatment. The primary outcome of the study is the number of days with headache, during a 28-day period.

Interventions

  • Drug: Saline injection
    • Half of the patients will be randomized to saline injections into the neck and head muscles
  • Procedure: Placebo
    • Half of the group will be treated with needle stings without injections

Arms, Groups and Cohorts

  • Experimental: Sodium chloride injection
    • Sodium chloride 9mg/ml by injection
  • Placebo Comparator: Needle sting
    • Brief needle stings without injection

Clinical Trial Outcome Measures

Primary Measures

  • Change in number of Days with headache
    • Time Frame: change between baseline 28 day period prior injection1 and 28 day period ending study
    • A headache day is defined as: 1) a day with headache ≥ 4 hours or 2) a day with headache of any duration, where the headache is relieved with acute headache medication (AHM) By AHM is meant a drug that is taken when needed for the purpose of relieving headaches, including any of the following: Paracetamol Aspirin NSAID Triptan Opioid Ergotamine Dihydroergotamine The primary efficacy measure is the change between the baseline 28-day period (4 weeks prior injection 1) and the corresponding period during follow-up, i.e. the 28-day period ending the study. a secondary efficacy measure is the change between the baseline and the 28-day period preceding the second injection.
  • Change in number of Days with headache
    • Time Frame: change between baseline and the 28-day period preceding the second injection
    • A headache day is defined as: 1) a day with headache ≥ 4 hours or 2) a day with headache of any duration, where the headache is relieved with acute headache medication. By AHM is meant a drug that is taken when needed for the purpose of relieving headaches, including any of the following: Paracetamol Aspirin NSAID Triptan Opioid Ergotamine Dihydroergotamine The primary efficacy measure is the change between the baseline 28-day period (4 weeks prior injection 1) and the corresponding period during follow-up, i.e. the 28-day period ending the study. a secondary efficacy measure is the change between the baseline and the 28-day period preceding the second injection.

Secondary Measures

  • Number of Days with moderate or severe headache
    • Time Frame: change between baseline 28 day period prior injection1 and 28 day period ending study
    • A headache day with moderate or severe intensity is defined as: 1) a day with headache ≥ 4 hours and with a peak of moderate or severe intensity or 2) a day with headache of any duration or intensity, where the headache is relieved with AHM. The primary efficacy measure is the change between the baseline 28-day period (4 weeks prior injection 1) and the corresponding period during follow-up, i.e. the 28-day period ending the study. a secondary efficacy measure is the change between the baseline and the 28-day period preceding the second injection.
  • Number of Days with moderate or severe headache
    • Time Frame: change between baseline and the 28-day period preceding the second injection
    • A headache day with moderate or severe intensity is defined as: 1) a day with headache ≥ 4 hours and with a peak of moderate or severe intensity or 2) a day with headache of any duration or intensity, where the headache is relieved with AHM. The primary efficacy measure is the change between the baseline 28-day period (4 weeks prior injection 1) and the corresponding period during follow-up, i.e. the 28-day period ending the study. a secondary efficacy measure is the change between the baseline and the 28-day period preceding the second injection.
  • Number of days with acute headache medication
    • Time Frame: change between baseline 28 day period prior injection1 and 28 day period ending study
    • Number of days the respondent stated that AHM has been taken.The primary efficacy measure is the change between the baseline 28-day period (4 weeks prior injection 1) and the corresponding period during follow-up, i.e. the 28-day period ending the study. a secondary efficacy measure is the change between the baseline and the 28-day period preceding the second injection.
  • Number of days with acute headache medication
    • Time Frame: change between baseline and the 28-day period preceding the second injection
    • Number of days the respondent stated that AHM has been taken.The primary efficacy measure is the change between the baseline 28-day period (4 weeks prior injection 1) and the corresponding period during follow-up, i.e. the 28-day period ending the study. a secondary efficacy measure is the change between the baseline and the 28-day period preceding the second injection.
  • Number of days with acute headache medication that requires prescription
    • Time Frame: change between baseline 28 day period prior injection1 and 28 day period ending study
    • Number of days the respondent stated that he or she has taken acute headache medication that require prescription, ie all drugs in the list in primary outcome above that require prescription by a doctor.The primary efficacy measure is the change between the baseline 28-day period (4 weeks prior injection 1) and the corresponding period during follow-up, i.e. the 28-day period ending the study. a secondary efficacy measure is the change between the baseline and the 28-day period preceding the second injection.
  • Number of days with acute headache medication that requires prescription
    • Time Frame: change between baseline and the 28-day period preceding the second injection
    • Number of days the respondent stated that he or she has taken acute headache medication that require prescription, ie all drugs in the list in primary outcome above that require prescription by a doctor.The primary efficacy measure is the change between the baseline 28-day period (4 weeks prior injection 1) and the corresponding period during follow-up, i.e. the 28-day period ending the study. a secondary efficacy measure is the change between the baseline and the 28-day period preceding the second injection.
  • Change in outcome of disease-specific quality of Life: Migraine-specific Quality of Life Questionnaire (MSQ v2.1)
    • Time Frame: Change between baseline and 12 weeks after second injection
    • Change in Migraine-specific Quality of Life Questionnaire (MSQ v2.1)
  • Change in outcome of disease-specific implications: Headache Impact Test (HIT-6)
    • Time Frame: Change between baseline and 12 weeks after second injection
    • Change in Headache Impact Test (HIT-6)

Participating in This Clinical Trial

Inclusion Criteria

  • Participants must meet the diagnostic criteria for chronic migraine (headache that have occurred on at least 15 days per month, for at least three months. At least eight of the headache episodes must be typical for migraine).
  • Participants must be able to understand and give informed consent to participate in the study.
  • Participants must be aged 18-65 years.

Exclusion Criteria

  • Participants must not suffer from other medical conditions that may affect the outcome of the study, including Horton's headache, temporal arteritis, trigeminal neuralgia, chronic paroxysmal hemi-crania, atypical facial pain and headache of unknown cause.
  • Participants must not have medical conditions that require use of drugs that can affect the headache pattern (for example rheumatic disorders).
  • Participants must not suffer from malignant diseases.
  • Participants must not plan to make changes to existing prophylactic headache medication during the study. Patients may, if already on treatment, choose to continue this throughout the course of the study, or choose to stop the prophylactic treatment at least one week before the start of the baseline period.
  • Participants must not have an ongoing patient-doctor contact with the physician giving the injections.
  • Participants must not have an ongoing patient-doctor contact with the monitor of the study.
  • Participants must not have received injection therapy in the face, head or neck muscles (medical or cosmetic) less than three months before the start of the study, nor should they plan such treatment during the course of the study.
  • Participants must not be pregnant or plan pregnancy during the course of the study.
  • Participants must not breastfeed or plan to do so during the study.
  • Participants must not have any contraindications to injection therapy (such as disease with increased bleeding tendency or treatment with certain types of blood thinners).
  • Participants must have no difficulty understanding or making themselves understood in Swedish.
  • Participants must be able to fill out the headache diary and questionnaires.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 65 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Göteborg University
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Malin Kim, MD, Principal Investigator, Rehabilitation clinic, Southern Älvsborg Hospital
  • Overall Contact(s)
    • Anna Grimby Ekman, Assoc Prof, +4676 618 31 23, anna.ekman@gu.se

References

Cole JC, Lin P, Rupnow MF. Validation of the Migraine-Specific Quality of Life Questionnaire version 2.1 (MSQ v. 2.1) for patients undergoing prophylactic migraine treatment. Qual Life Res. 2007 Sep;16(7):1231-7. Epub 2007 Apr 28.

Dodick DW, Turkel CC, DeGryse RE, Aurora SK, Silberstein SD, Lipton RB, Diener HC, Brin MF; PREEMPT Chronic Migraine Study Group. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache. 2010 Jun;50(6):921-36. doi: 10.1111/j.1526-4610.2010.01678.x. Epub 2010 May 7.

Freitag FG, Diamond S, Diamond M, Urban G. Botulinum Toxin Type A in the treatment of chronic migraine without medication overuse. Headache. 2008 Feb;48(2):201-9. Epub 2007 Nov 28.

Gandek B, Alacoque J, Uzun V, Andrew-Hobbs M, Davis K. Translating the Short-Form Headache Impact Test (HIT-6) in 27 countries: methodological and conceptual issues. Qual Life Res. 2003 Dec;12(8):975-9.

Smelt AF, Assendelft WJ, Terwee CB, Ferrari MD, Blom JW. What is a clinically relevant change on the HIT-6 questionnaire? An estimation in a primary-care population of migraine patients. Cephalalgia. 2014 Jan;34(1):29-36. doi: 10.1177/0333102413497599. Epub 2013 Jul 10.

Goadsby PJ. Migraine pathophysiology. Headache. 2005 Apr;45 Suppl 1:S14-24. Review.

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