- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT07568496
Greater Occipital Nerve Block for Migraine With Medication Overuse Headache (GONB_MOH)
11. mai 2026 oppdatert av: Pannathat Soontrapa, Mahidol University
Migraine is among the leading causes of disability worldwide.
Inappropriate use of acute medications in the setting of primary headache, particularly migraine can result in a debilitating condition known as medication overuse headache (MOH).
Treatment of MOH is challenging and the primary therapeutic approach is reducing painkillers which helps decrease the number of headache days.
As a part of the detoxification process to discontinue acute medications, bridging therapy is often needed to reduce withdrawal headache.
Currently, there are data supporting the use of greater occipital nerve block as a preventive treatment in chronic migraine, but no placebo-controlled trial has evaluated the efficacy of greater occipital nerve block in MOH.
Therefore, this research aims to demonstrate the efficacy of greater occipital nerve block in detoxification of migraine patients with MOH.
Patients will be recruited from Headache Clinic at 3 centers in Thailand from February 2026 to January 2028.
After recruitment, patients will be randomized into 2 groups at a 1:1 ratio using a block of four, namely group A and B. A 5-mL syringe of 2 mL of lidocaine 2% and 2 mL of methylprednisolone 40 mg/mL (80 mg) will be prepared for each patient in group while a 5-mL syringe of 4 mL normal saline will be prepared for each patient in group B. Monthly headache days, duration, severity, acute medication type and number of usage days and relative headache status according to a 5-point Likert scale will be investigated at the 2 weeks, 1st, 2nd and 3rd month, MIDAS at the end of 3rd month.
Studieoversikt
Status
Har ikke rekruttert ennå
Intervensjon / Behandling
Studietype
Intervensjonell
Registrering (Antatt)
130
Fase
- Ikke aktuelt
Kontakter og plasseringer
Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.
Studiekontakt
- Navn: Pannathat Soontrapa, M.D.
- Telefonnummer: +6690-568-6388
- E-post: pannathat.soo@mahidol.ac.th
Studiesteder
-
-
Bangkok
-
Bangkok, Bangkok, Thailand, 10700
- Faculty of Medicine Siriraj Hospital, Mahidol University
-
Ta kontakt med:
- Pannathat Soontrapa, M.D.
- Telefonnummer: 662-4197101-2
- E-post: pannathat.soo@mahidol.edu
-
Hovedetterforsker:
- Pannathat Soontrapa, M.D.
-
-
Changwat Songkhla
-
Hat Yai, Changwat Songkhla, Thailand, 90110
- Faculty of Medicine, Prince of Songkla University
-
Ta kontakt med:
- Prut Koonalintip, M.D.
- Telefonnummer: 6689-7846676
- E-post: koo.prut@gmail.com
-
Underetterforsker:
- Prut Koonalintip, M.D.
-
-
Chiang Mai
-
Chiang Mai, Chiang Mai, Thailand, 50200
- Faculty of Medicine, Chiang Mai University
-
Ta kontakt med:
- Surat Tanprawate, M.D.
- Telefonnummer: 6683-2032103
- E-post: surat.tan@cmu.ac.th
-
Underetterforsker:
- Surat Tanprawate, M.D.
-
-
Deltakelseskriterier
Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
- Voksen
- Eldre voksen
Tar imot friske frivillige
Nei
Beskrivelse
Inclusion Criteria:
- Patients who have a diagnosis of migraine with medication overuse headache according to ICHD-3 criteria confirmed by a neurologist
- Female patients will be screened for pregnancy planning and married female patients must undergo a urine pregnancy test
Exclusion Criteria:
- Patients who have other types of headache disorders other than migraine
- Patients who have a previous history of allergy to corticosteroid or lidocaine
- Patients who had previous skull surgery
- Pregnant women
- Patients with a history of uncontrolled depression, or psychosis
- Patients who get or plan to get CGRP-targeted therapies or botulinum toxin injection
- Patients with an increased risk of bleeding or underlying bleeding disorders
Studieplan
Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Enkelt
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
|---|---|
|
Aktiv komparator: Active treatment (GONB)
Participants receive Greater Occipital Nerve Block (GONB) with 2% Lidocaine + methylprednisolone 80 mg
|
A 4-mL injection containing 2 mL of lidocaine 2% and 2 mL of methylprednisolone 40 mg/mL (80 mg).
The injection is administered at the medial third of the distance between the external occipital protuberance and the mastoid process.
|
|
Placebo komparator: Placebo group
Participants receive occipital injection with Normal Saline (0.9% NaCl).
|
A 4-mL injection of 0.9% Normal Saline administered at the medial third of the distance between the external occipital protuberance and the mastoid process.
|
Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
Percentage of patients with Medication Overuse Headache (MOH)
Tidsramme: At the end of month 1 and month 3 after detoxification.
|
The percentage of participants diagnosed with Medication Overuse Headache (MOH) according to ICHD criteria.
|
At the end of month 1 and month 3 after detoxification.
|
Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
Percentage of patients achieving 50% improvement in migraine
Tidsramme: At the end of month 3.
|
The percentage of patients with at least a 50% reduction in monthly headache days compared to baseline (month -1).
|
At the end of month 3.
|
|
Change in monthly headache days
Tidsramme: Baseline (month -1) and month 3.
|
The mean change in the number of headache days per month from baseline to month 3.
|
Baseline (month -1) and month 3.
|
|
Change in mean headache severity
Tidsramme: Baseline (month -1) and month 3.
|
The change in mean headache severity scores measured by the Visual Analog Scale (VAS).
0 being no pain and 10 being the worst pain
|
Baseline (month -1) and month 3.
|
|
Change in Migraine Disability Assessment (MIDAS) Score
Tidsramme: Baseline (month -1) and month 3.
|
Evaluation of the change in disability caused by migraines using the MIDAS questionnaire.
MIDAS score ranges from 0 to 270 with the higher score, the worse disability.
|
Baseline (month -1) and month 3.
|
Samarbeidspartnere og etterforskere
Det er her du vil finne personer og organisasjoner som er involvert i denne studien.
Sponsor
Publikasjoner og nyttige lenker
Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.
Generelle publikasjoner
- Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. doi: 10.1177/0333102417738202. No abstract available.
- Stewart WF, Lipton RB, Dowson AJ, Sawyer J. Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability. Neurology. 2001;56(6 Suppl 1):S20-8. doi: 10.1212/wnl.56.suppl_1.s20.
- Gosalia H, Moreno-Ajona D, Goadsby PJ. Medication-overuse headache: a narrative review. J Headache Pain. 2024 May 31;25(1):89. doi: 10.1186/s10194-024-01755-w.
- GBD 2023 Headache Collaborators. Global, regional, and national burden of headache disorders, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet Neurol. 2025 Dec;24(12):1005-1015. doi: 10.1016/S1474-4422(25)00402-8.
- Arab A, Khoshbin M, Karimi E, Saberian G, Saadatnia M, Khorvash F. Effects of greater occipital nerve block with local anesthetic and triamcinolone for treatment of medication overuse headache: an open-label, parallel, randomized, controlled clinical trial. Neurol Sci. 2022 Jan;43(1):549-557. doi: 10.1007/s10072-021-05295-y. Epub 2021 May 4.
- Inan LE, Inan N, Unal-Artik HA, Atac C, Babaoglu G. Greater occipital nerve block in migraine prophylaxis: Narrative review. Cephalalgia. 2019 Jun;39(7):908-920. doi: 10.1177/0333102418821669. Epub 2019 Jan 6.
- Chowdhury D, Tomar A, Deorari V, Duggal A, Krishnan A, Koul A. Greater occipital nerve blockade for the preventive treatment of chronic migraine: A randomized double-blind placebo-controlled study. Cephalalgia. 2023 Feb;43(2):3331024221143541. doi: 10.1177/03331024221143541.
- Diener HC, Marmura MJ, Tepper SJ, Cowan R, Starling AJ, Diamond ML, Hirman J, Mehta L, Brevig T, Sperling B, Cady R. Efficacy, tolerability, and safety of eptinezumab in patients with a dual diagnosis of chronic migraine and medication-overuse headache: Subgroup analysis of PROMISE-2. Headache. 2021 Jan;61(1):125-136. doi: 10.1111/head.14036. Epub 2020 Dec 13.
- Silberstein SD, Cohen JM, Seminerio MJ, Yang R, Ashina S, Katsarava Z. The impact of fremanezumab on medication overuse in patients with chronic migraine: subgroup analysis of the HALO CM study. J Headache Pain. 2020 Sep 21;21(1):114. doi: 10.1186/s10194-020-01173-8.
- Dodick DW, Doty EG, Aurora SK, Ruff DD, Stauffer VL, Jedynak J, Dong Y, Pearlman EM. Medication overuse in a subgroup analysis of phase 3 placebo-controlled studies of galcanezumab in the prevention of episodic and chronic migraine. Cephalalgia. 2021 Mar;41(3):340-352. doi: 10.1177/0333102420966658. Epub 2020 Nov 3.
- Koonalintip P, Phillips K, Wakerley BR. Medication-Overuse Headache: Update on Management. Life (Basel). 2024 Sep 11;14(9):1146. doi: 10.3390/life14091146.
- Vandenbussche N, Laterza D, Lisicki M, Lloyd J, Lupi C, Tischler H, Toom K, Vandervorst F, Quintana S, Paemeleire K, Katsarava Z. Medication-overuse headache: a widely recognized entity amidst ongoing debate. J Headache Pain. 2018 Jul 13;19(1):50. doi: 10.1186/s10194-018-0875-x.
- Shand B, Goicochea MT, Valenzuela R, Fadic R, Jensen R, Tassorelli C, Nappi G; COMOESTAS CONSORTIUM. Clinical and Demographical Characteristics of Patients with Medication Overuse Headache in Argentina and Chile: Analysis of the Latin American Section of COMOESTAS Project. J Headache Pain. 2015;16:83. doi: 10.1186/s10194-015-0561-1. Epub 2015 Sep 18.
Studierekorddatoer
Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.
Studer hoveddatoer
Studiestart (Antatt)
1. mai 2026
Primær fullføring (Antatt)
1. november 2028
Studiet fullført (Antatt)
1. november 2028
Datoer for studieregistrering
Først innsendt
28. april 2026
Først innsendt som oppfylte QC-kriteriene
28. april 2026
Først lagt ut (Faktiske)
5. mai 2026
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
13. mai 2026
Siste oppdatering sendt inn som oppfylte QC-kriteriene
11. mai 2026
Sist bekreftet
1. mai 2026
Mer informasjon
Begreper knyttet til denne studien
Nøkkelord
Ytterligere relevante MeSH-vilkår
- Hjernesykdommer
- Sykdommer i sentralnervesystemet
- Sykdommer i nervesystemet
- Hodepinelidelser, Primær
- Hodepine lidelser
- Migrene lidelser
- Hodepinelidelser, sekundær
- Organiske kjemikalier
- Polysykliske forbindelser
- Anilider
- Amides
- Anilinforbindelser
- Aminer
- Acetanilider
- Gravadienes
- Gravaner
- Steroider
- Smeltede ringforbindelser
- Gravadienetrioler
- Prednisolon
- Lidokain
- Metylprednisolon
Andre studie-ID-numre
- Si321/2026
Plan for individuelle deltakerdata (IPD)
Planlegger du å dele individuelle deltakerdata (IPD)?
NEI
Legemiddel- og utstyrsinformasjon, studiedokumenter
Studerer et amerikansk FDA-regulert medikamentprodukt
Nei
Studerer et amerikansk FDA-regulert enhetsprodukt
Nei
Denne informasjonen ble hentet direkte fra nettstedet clinicaltrials.gov uten noen endringer. Hvis du har noen forespørsler om å endre, fjerne eller oppdatere studiedetaljene dine, vennligst kontakt register@clinicaltrials.gov. Så snart en endring er implementert på clinicaltrials.gov, vil denne også bli oppdatert automatisk på nettstedet vårt. .