Cluster Headache
Conditions
Keywords
Cluster Headache, Botulinum Toxin Type A, Sphenopalatine Ganglion Block, Autonomic Nerve Block
Brief summary
Cluster headache is an intense and powerful, one-sided headache accompanied by involuntary symptoms such as red eye, droopy eyelids, flow of tears, small pupils and one-sided facial sweating. The headache is believed to be the most intense of all headaches and among many is totally disabling and of great personal and social consequences. For a small group of patients with episodic and most chronic form, drug therapy has little effect. For them, surgery can be a solution. Neuroradiology has found evidence of a possible original activation of cluster headache from the portion of the brain called hypothalamus. Furthermore, an activation of the parasympathetic nervous system through the sphenopalatine ganglion, which may also explain some of the one-sided involuntary symptoms, is suspected in cluster headache. Injection of Botulinum toxin type A (BTA) inhibits secretion of synaptic acetylcholine resulting in nerve signals being blocked. The duration of such a blockade is believed to be 3-9 months. The purpose of the present study is to develop and evaluate a new surgical procedure with injection of BTA for blocking of the sphenopalatine ganglion. The goal is to relieve the symptoms of refractory cluster headache with a minimal invasive procedure. The main objective of the project is to determine the safety of BTA injection in the area of the sphenopalatine ganglion of refractory cluster headache and detect the adverse events. Secondary objectives are to identify the changes of headache attacks by the method used.
Interventions
DRUGBotulinum Toxin Type A 50 IU
Sponsors
St. Olavs Hospital
Norwegian University of Science and Technology
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Informed and written consent * Cluster headaches defined in ICHD-2 criteria, duration of periods of attacks normally more than 2 months and insufficient effect of available prophylactic treatment
Exclusion criteria
* Heart or lung disease * Any kind of systematic or local disease or illness that may significantly increase the risk of complications for the procedure, related to injection or anesthesia * Psychiatric illness that hinders participation in the study * Known pregnancy or breast feeding * Inadequate use of contraceptives * Overuse or abuse of opioids * Abuse of medications, narcotics or alcohol * Allergy or any other hypersensitivity reactions against marcain, lidocaine, xylocain or adrenalin, botulinum toxin type A, Botox or any of it's constituents or any other related medication * Treatment with medication that can interact with botulinum toxin type A
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Safety aspects / Number of adverse events and number of participants with adverse events as a measure of safety | For the follow-up period of 6 months | Number of adverse events and number of participants with adverse events after BTA injection in the area of the sphenopalatine ganglion and severity of adverse events. Registration of any adverse events categorized by probable relationship to drug, the surgical procedure or anesthesia. Data obtained from the headache diaries as well as open questions during consultations. |
Secondary
| Measure | Time frame |
|---|---|
| Cluster headache attack frequency | Average number of attacks of baseline compared to average of week 3 and 4 after injection |
| Hours with cluster headache | Average of baseline compared to average of week 3 and 4 after injection |
| Days with cluster headache | Average of baseline compared to average of week 3 and 4 after injection |
Countries
Norway
Outcome results
None listed