- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04702971
Decoding Pain Sensitivity in Migraine With Multimodal Brainstem-based Neurosignature
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Migraine causes a tremendous disease burden around the world. Migraine is one of the most prevalent neurological disorders and is reported by the WHO as the second leading cause of disease-related disabilities globally (No. 1 in the population under the 50s). There has been no much change in the ranking of disability for migraine for the past two decades, reflecting an unmet need for better treatment options. Even with the recently available calcitonin-gene related peptide (CGRP)-based treatment, the treatment response versus placebo is still disappointing (6.4-17.6% in acute treatment, 10.2-23.7% in preventive treatment). There is an urgent need to push further the current understanding of the pathophysiology of migraine, based on which novel treatment strategies can be developed. The lack of appropriate research tools hinders the acceleration of migraine research. As a neurological disorder, many neuroimaging studies have been focused on brain alterations; however, the majority focused on the cerebrum. Limited by the currently available neuroimaging and electrophysiological technologies, the deep brain structures especially the brainstem involved in the sensory and nociceptive neurotransmission in migraine, such as the trigeminal nucleus, could only be investigated to a limited extent. Obviously, there is an unmet need for novel technologies that can be used to delineate structural or functional alterations in the brainstem. Elucidation of the role of these deep brain structures may fill the gap in the current understanding of migraine pathophysiology, and pave the way to precise and efficient treatment. Studies restricted to single methodologies are insufficient for the complexity of migraine. Migraine is a complex and dynamic disorder. However, most prior studies were limited to single methodologies and provided limited insights into such a multifaceted disorder. Studies with an integrated approach are lacking. An exhaustive examination of the discrete components of a phenotype, i.e., 'deep phenotyping', can help understand different aspects of its clinical manifestations, and facilitate patient classification. Coupled with neuroimaging and electrophysiological research methodologies, a multi-modal decoding approach would help identify a constellation of migraine-specific biosignatures, rather than just one. This can not only provide clues to decipher migraine pathophysiology in various dimensions but also serve as the basis of the development of a prediction algorithm that can be applied in clinical practice. To pursue the overall goal, the present project schemes as a composition of the following 5 aims:
Aim 1: Deep phenotyping for sensory processing in patients with migraine Aim 2: Brainstem-based functional and structural connectomics in migraine Aim 3: Capturing brainstem electro-neurosignature in migraine Aim 4: Constructing a data fusion platform and developing an EEG cap with a built-in analytic chip Aim 5: Exploring brainstem-based connectome sequencing in migraine animal model
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Shuu-Jiun Wang
- Phone Number: 28712121
- Email: k123wang@gmail.com
Study Contact Backup
- Name: Li-Ling Pan
- Email: hope881212@hotmail.com
Study Locations
-
-
-
Taipei, Taiwan, 112
- Recruiting
- Headache Center, Teipei Veterans General Hospital
-
Contact:
- Shuu-Jiun Wang, MD
- Phone Number: 7578 +886-2-28712121
- Email: sjwang@vghtpe.gov.tw
-
Contact:
- Li-Ling Pan, Ph.D.
- Phone Number: 1291 +886-2-28712121
- Email: hope881212@hotmail.com
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Migraine:
Inclusion criteria:
- fulfill the diagnostic criteria of migraine in ICHD-3,
- 20-65 yrs,
- understand the study design and willing to join the study
- at least four headache days per month,
- the onset of headache is prior to 50 yrs.,
- normal neurological examination findings.
Exclusion criteria:
- history or family history of epilepsy,
- taking migraine prophylactics,
- women who are breastfeeding or pregnant,
- severe psychological disorders, including major depression, PTSD, personality disorders, bipolar disorder, schizophrenia,
- medical, neurological or psychiatric disease discovered by the researcher that would hinder the research,
- contraindications for MR scan (pacemaker, claustrophobia, stent, metal implants…).
Healthy:
Inclusion criteria:
- 20-65 yrs,
- normal neurological examination findings,
- understand the study design and willing to join the study.
Exclusion criteria:
- history or family history of epilepsy,
- women who are breastfeeding or pregnant,
- severe psychological disorders, including major depression, PTSD, personality disorders, bipolar disorder, schizophrenia,
- medical, neurological or psychiatric disease discovered by the researcher that would hinder the research,
- contraindications for MR scan (pacemaker, claustrophobia, stent, metal implants…),
- history of headache will be included (the tension-type headache occurs < 1 time per month is allowed)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: patients with migraine
patient with migraine will be prescribed with flunarizine or routine clinical care per clinician's decision based on the condition of each individual patient
|
The flunarizine will be given per clinical routine
|
Other: healthy control
|
no intervention for healthy control
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Clinical change after treatment (1) headache frequency
Time Frame: 6 months
|
clinical change (headache frequency) after treatment unit: attacks per month analysis: comparing the mean headache frequency in each month after treatment (M1/M2/M3/M4/M5/M6) to that before treatment (M0)
|
6 months
|
Clinical change after treatment (2) headache intensity
Time Frame: 6 months
|
clinical change (headache intensity) after treatment unit: NRS (numeric rating scale, 0-10) analysis: comparing the mean headache intensity in each month after treatment (M1/M2/M3/M4/M5/M6) to that before treatment (M0)
|
6 months
|
Clinical change after treatment (3) headache duration
Time Frame: 6 months
|
clinical change (headache duration) after treatment unit: hours/day analysis: comparing the mean headache duration (hours/day) in each month after treatment (M1/M2/M3/M4/M5/M6) to that before treatment (M0)
|
6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
EEG change after treatment (1) Linear analysis of EEG before and after treatment
Time Frame: 12 months
|
power spectral density change of EEG before and after treatment • Four EEG sessions will be arranged. The first one is done before treatment, and the 2nd/3rd/4th one will be done after a 3-month/6-month/12-month treatment course, respectively. |
12 months
|
EEG change after treatment (2) Nonlinear analysis of EEG before and after treatment
Time Frame: 12 months
|
functional connectivity change of EEG before and after treatment • Four EEG sessions will be arranged. The first one is done before treatment, and the 2nd/3rd/4th one will be done after a 3-month/6-month/12-month treatment course, respectively. |
12 months
|
EEG change after treatment (3) Nonlinear analysis of EEG before and after treatment
Time Frame: 12 months
|
evoked potential amplitude change of EEG before and after treatment • Four EEG sessions will be arranged. The first one is done before treatment, and the 2nd/3rd/4th one will be done after a 3-month/6-month/12-month treatment course, respectively. |
12 months
|
Sensory threshold change after treatment
Time Frame: 12 months
|
Using quantitative sensory testing (QST) to evaluate the sensory threshold before and after treatment • Four standard QST sessions will be arranged. The first one is done before treatment, and the 2nd/3rd/4th one will be done after a 3-month/6-month/12-month treatment course, respectively. |
12 months
|
fMRI change after treatment (1)
Time Frame: 12 months
|
functional connectivity change of fMRI before and after treatment • Three fMRI sessions will be arranged. The first one is done before treatment, and the 2nd/3rd one will be done after a 6-month/12-month treatment course, respectively. |
12 months
|
fMRI change after treatment (2)
Time Frame: 12 months
|
activation change of fMRI before and after treatment • Three fMRI sessions will be arranged. The first one is done before treatment, and the 2nd/3rd one will be done after a 6-month/12-month treatment course, respectively. |
12 months
|
MRI change after treatment (1)
Time Frame: 12 months
|
VBM changes of MRI before and after treatment • Three MRI sessions will be arranged. The first one is done before treatment, and the 2nd/3rd one will be done after a 6-month/12-month treatment course, respectively. |
12 months
|
MRI change after treatment (2)
Time Frame: 12 months
|
SBM changes of MRI before and after treatment • Three MRI sessions will be arranged. The first one is done before treatment, and the 2nd/3rd one will be done after a 6-month/12-month treatment course, respectively. |
12 months
|
Humoral change after treatment (1)
Time Frame: 12 months
|
Test the cytokine level using ELISA kit to evaluate the status before and after treatment • Four blood test sessions and saliva collection will be arranged. The first one is done before treatment, and the 2nd/3rd/4th one will be done after a 3-month/6-month/12-month treatment course, respectively. |
12 months
|
Humoral change after treatment (2)
Time Frame: 12 months
|
Test the hormone level using ELISA kit to evaluate the status before and after treatment • Four blood test sessions and saliva collection will be arranged. The first one is done before treatment, and the 2nd/3rd/4th one will be done after a 3-month/6-month/12-month treatment course, respectively. |
12 months
|
Genetic variance
Time Frame: 5 minutes
|
Genetic variants associated with baseline demographics and treatment response as assessed with genome-wide association study using the genotyping data derived from the Axiom Genome-wide array • Blood draw before the treatment to extract DNA for further sequencing |
5 minutes
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Headache Disorders, Primary
- Headache Disorders
- Migraine Disorders
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Vasodilator Agents
- Membrane Transport Modulators
- Anticonvulsants
- Calcium-Regulating Hormones and Agents
- Calcium Channel Blockers
- Histamine H1 Antagonists
- Histamine Antagonists
- Histamine Agents
- Flunarizine
Other Study ID Numbers
- 2020-11-004C
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Migraine
-
Austrian Migraine Registry CollaborationMedical University of Vienna; Medical University Innsbruck; Austrian Headache...RecruitingMigraine | Chronic Migraine | Migraine Without Aura | Migraine With Aura | Episodic MigraineAustria
-
Tonix Pharmaceuticals, Inc.PremierCompletedChronic Migraine | Chronic Migraine, Headache | Chronic Migraine Without Aura | Aura MigraineUnited States
-
Harvard University Faculty of MedicineBrigham and Women's Hospital; Palmer Center for Chiropractic Research (PCCR)CompletedMigraine | Migraine Disorders | Migraine Without Aura | Migraine With Aura | Migraine, ClassicUnited States
-
University of FlorenceAzienda Ospedaliera Città della Salute e della Scienza di Torino; University... and other collaboratorsRecruitingMigraine | Chronic Migraine | Migraine Without Aura | Migraine With AuraItaly
-
CoolTech LLCTerminatedMigraine | Migraine Without Aura | Migraine With Aura | Episodic MigraineUnited States
-
University of FlorenceAzienda Ospedaliera Città della Salute e della Scienza di Torino; University... and other collaboratorsRecruitingMigraine | Chronic Migraine | Migraine Without Aura | Migraine With AuraItaly
-
Notre-Dame Hospital, Montreal, Quebec, CanadaAllerganCompletedChronic Migraine | Migraine Without Aura | Migraine With AuraCanada
-
Glostrup University Hospital, CopenhagenUnknownChronic Migraine | Migraine Without Aura | Migraine With AuraDenmark
-
Fondazione I.R.C.C.S. Istituto Neurologico Carlo...CompletedMigraine With Aura | Migraine in ChildrenItaly
-
The Cleveland ClinicWithdrawnMigraine | Migraine Disorders | Headache Disorders, Primary | Migraine Headache | Migraine Without Aura | Migraine With Aura | Headache, MigraineUnited States
Clinical Trials on Flunarizine
-
Shanghai University of Traditional Chinese MedicineCompleted
-
University of British ColumbiaTerminatedJuvenile Myoclonic Epilepsy | Childhood Absence Epilepsy | Juvenile Absence EpilepsyCanada
-
Johnson & Johnson Pharmaceutical Research & Development...Jan-Cil Italy; Jan-Cil Spain; Jan-Cil UK; Jan-Cil SwitzerlandCompletedMigraine | Human Volunteers
-
The Third Affiliated hospital of Zhejiang Chinese...Recruiting
-
Taipei Veterans General Hospital, TaiwanMinistry of Science and Technology, R.O.C.CompletedChronic Pain | Fibromyalgia | Chronic MigraineTaiwan
-
All India Institute of Medical Sciences, BhubaneswarCompleted
-
Shalamar Institute of Health SciencesNot yet recruitingMigraine | ProphylaxisPakistan
-
Taipei Veterans General Hospital, TaiwanCompletedChronic Migraine
-
Ambulatório de BipolaridadeStanley Medical Research InstituteCompleted
-
Ataturk UniversityCompleted