Post-Traumatic Headache
Conditions
Keywords
psilocybin
Brief summary
The purpose of this study is to investigate the effects of oral psilocybin in post-traumatic headache. Subjects will be randomized to receive placebo, low dose psilocybin, or high dose psilocybin on two separate test days approximately 14 days apart. Subjects will maintain a headache diary prior to, during, and after the treatments in order to document headache frequency and intensity, as well as associated symptoms. Blood samples will be drawn at various timepoints to measure levels of inflammatory peptides.
Interventions
DRUGPlacebo oral capsule
microcrystalline cellulose capsule
0.0143 mg/kg psilocybin capsule (weight-based option) or 1 mg psilocybin capsule (fixed-dose option)
0.143 mg/kg psilocybin capsule (weight-based option) or 10 mg psilocybin capsule (fixed-dose option)
Sponsors
Yale University
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
21 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Diagnosis of post-traumatic headache * Typical pattern of headache attacks with approximately two attacks or more weekly * Attacks are managed by means involving no more than twice weekly triptan use
Exclusion criteria
* Axis I psychotic disorder (e.g. schizophrenia, bipolar I, depression with psychosis) * Axis I psychotic disorder in first degree relative * Unstable medical condition, severe renal, cardiac or hepatic disease, pacemaker, or serious central nervous system pathology * Pregnant, breastfeeding, lack of adequate birth control * History of intolerance to psilocybin, LSD, or related compounds * Drug or alcohol abuse within the past 3 months (excluding tobacco) * Urine toxicology positive to drugs of abuse * Use of vasoconstrictive medications (i.e. sumatriptan, pseudoephedrine, midodrine) within 5 half-lives of test days * Use of serotonergic antiemetics (i.e. ondansetron) in the past 2 weeks * Use of antidepressant medication (i.e. TCA, MAOI, SSRI) in the past 6 weeks * Use of steroids or certain other immunomodulatory agents (i.e. azathioprine) in the past 2 weeks
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in intensity of functional disability during headache attacks | From two weeks before first session to two weeks after second session using a headache diary | Average intensity of functional disability (4-tiered pain score; 0=none, 1=mild, 2=moderate, 3=severe) |
| Acute change in photophobia | Measured at 0, 1, 2, 4, and 24 hours after drug administration | 4-tiered pain score (0=none, 1=mild, 2=moderate, 3=severe) |
| Acute change in phonophobia | Measured at 0, 1, 2, 4, and 24 hours after drug administration | 4-tiered pain score (0=none, 1=mild, 2=moderate, 3=severe) |
| Acute change in functional disability | Measured at 0, 1, 2, 4, and 24 hours after drug administration | 4-tiered pain score (0=none, 1=mild, 2=moderate, 3=severe) |
| Time to first headache attack | Two weeks following each test session | Measured in days |
| Time to last headache attack | Two weeks following each test session | Measured in days |
| Change in headache attack frequency | From two weeks before first session to two weeks after second session using a headache diary | Average number (number per week) |
| Change in headache attack duration | From two weeks before first session to two weeks after second session using a headache diary | Average duration (measured in hours) |
| Change in pain intensity of headache attacks | From two weeks before first session to two weeks after second session using a headache diary | Average pain intensity (4-tiered pain score; 0=none, 1=mild, 2=moderate, 3=severe) |
| Change in intensity of nausea/vomiting during headache attacks | From two weeks before first session to two weeks after second session using a headache diary | Average intensity of nausea/vomiting (4-tiered pain score; 0=none, 1=mild, 2=moderate, 3=severe) |
| Change in intensity of photophobia during headache attacks | From two weeks before first session to two weeks after second session using a headache diary | Average intensity of photophobia (4-tiered pain score; 0=none, 1=mild, 2=moderate, 3=severe) |
| Change in intensity of phonophobia during headache attacks | From two weeks before first session to two weeks after second session using a headache diary | Average intensity of phonophobia (4-tiered pain score; 0=none, 1=mild, 2=moderate, 3=severe) |
| Acute change in pain intensity | Measured at 0, 1, 2, 4, and 24 hours after drug administration | 4-tiered pain score (0=none, 1=mild, 2=moderate, 3=severe) |
| Acute change in nausea/vomiting | Measured at 0, 1, 2, 4, and 24 hours after drug administration | 4-tiered pain score (0=none, 1=mild, 2=moderate, 3=severe) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Headache attack-free time | From two weeks before first session to two weeks after second session using a headache diary | Number of 24 hour days (may be non-consecutive) |
| Quality of life using the Centers for Disease Control (CDC) Health-Related Quality of Life Scale: Healthy Days Symptoms Module | From two weeks before first session to two weeks after second session using a headache diary | 4 questions scored 0 to 30 each; higher numbers indicate worse quality of life. (1) pain-related impairment, (2) mood symptoms, (3) anxiety symptoms, and (4) lack of sleep Percent change for each measure as well as total score (range 0 to 120) will be calculated. |
| Depression using Patient Health Questionnaire 9 (PHQ-9) | From two weeks before first session to two weeks after second session using a headache diary | 9 question self-report questionnaire to assess the presence of depression-related symptoms. Each question is rated on a scale of 0-3 (0 = Not at all; 1 = Several days; 2 = More than half the days; 3 = Nearly every day). Higher scores indicate greater presence of depression-related symptoms. Total score is calculated. Total score 5-9 = minimal symptoms; total score 10-14 = Major Depression, mild; total score 15-19 = Major Depression, moderately severe; total score \>20 = Major Depression severe. |
| Suicide risk using the Columbia Suicide Severity Rating Scale (CSSRS) | From two weeks before first session to two weeks after second session using a headache diary | A 10-category assessment of suicidal ideation and behavior. 5 categories (scored yes/no) relate to the presence of suicidal ideation. 5 categories (scored yes/no) relate to the presence of suicidal behavior. A yes to any of the suicidal ideation categories indicates the presence of suicidal ideation; a yes to any of the suicidal behavior categories indicates the presence of suicidal behavior. |
| Psychedelic effects using the 5-Dimensional Altered States of Consciousness (5D-ASC) scale | Taken on each test day approximately 6 hours after drug administration | 94 questions scored 0 to 100 each; higher numbers indicate greater psychedelic effects Questions address 5 dimensions: (1) Oceanic boundlessness (score range 0-2700), (2) Dread of Ego Dissolution (score range 0-2100), (3) Visionary Restructuralization (score range 0-1800), (4) Auditory Alterations (score range 0-1600), and (5) Vigilance reduction (score range 0-1200) Score for each dimension as well as total score (range 0 to 9400) will be measured. |
| Change in blood pressure | Measured during each test session prior to drug administration, every 15 min in the first hour, every 30 min in the second hour, and then hourly for 4 hours or until resolution of psychedelic effects (~6 hours post drug) | Maximum change from baseline during each test day (mmHg) |
| Change in heart rate | Measured during each test session prior to drug administration, every 15 min in the first hour, every 30 min in the second hour, and then hourly for 4 hours or until resolution of psychedelic effects (~6 hours post drug) | Maximum change from baseline during each test day (beats per minute) |
| Change in peripheral oxygenation | Measured during each test session prior to drug administration, every 15 min in the first hour, every 30 min in the second hour, and then hourly for 4 hours or until resolution of psychedelic effects (~6 hours post drug) | Maximum change from baseline during each test day (SpO2) |
| Change in peripheral levels of calcitonin gene-related peptide (CGRP) | Measured during each test session prior to drug administration, and at 2 and 4 hours after drug administration | Change from baseline during each test day (pg/mg protein) |
| Change in peripheral levels of pituitary adenylate cyclase-activating peptide (PACAP) | Measured during each test session prior to drug administration, and at 2 and 4 hours after drug administration | Change from baseline during each test day (pg/mg protein) |
| Use of abortive/rescue medication | From two weeks before first session to two weeks after second session using a headache diary | number of times per week |
Countries
United States
Outcome results
None listed