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Completed

NCT Number: NCT02549898

Investigation of Vascular Inflammation in Migraine Using Molecular Nano-imaging and Black Blood Imaging MRI

The investigators aim to investigate inflammation of cranial and meningeal arteries during pharmacologically induced migraine attacks, using ultrasmall superparamagnetic iron oxide (USPIO) nanoparticles and black blood imaging (BBI) MRI.

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Key information

Conditions

Migraine Headache Brain Diseases Central Nervous System Diseases Headache Disorders Headache Disorders, Primary Migraine Disorders Migraine Without Aura Nervous System Diseases

Age range

18 year–50 year

Sex eligibility

Female

Study type

Interventional

Phase

Not applicable

Primary location

Rigshospitalet Glostrup

Glostrup Municipality, 2600, Denmark

About this study

Migraine is the most common neurological disorder, ranked as the 7th most debilitating disease worldwide by the WHO. While much research has been and continues to be conducted to illuminate the enigma of migraine pathophysiology, key aspects still remain a conundrum. Specifically, the process of headache generation is perhaps the most complex and debated part of migraine pathophysiology. The vascular hypothesis of migraine has traditionally focused on the simple dilatation of cranial arteries. However, a possible contribution of perivascular pain sensitive structures should also be considered, as aseptic inflammation of the arterial walls and perivascular space may activate afferent nerve endings. Interestingly, giant cell arteritis caused by aseptic arterial wall inflammation may present clinically as localized headache with migraine-like features (i.e. throbbing pain, localized in the temporal region, and allodynia).

The primary trigeminal nociceptor is the first integral part of the headache-generating pathway. Animal models of migraine have suggested that activation and sensitization of perivascular trigeminal nociceptors caused by inflammatory substances may explain head pain in migraine. However, there is no human evidence to date to suggest perivascular and arterial wall inflammation as a source of pain in migraine.

The investigators hypothesize that unilateral migraine without aura is associated with ipsilateral inflammation of the cranial arteries and meninges. The investigators also suggest that sumatriptan inhibits this perivascular inflammation. To test the hypotheses the investigators will perform MRI scans on subjects with provoked migraine attacks, using two different methods to visualize perivascular inflammation: USPIO-MRI, using iron-oxide nanoparticles as contrast agent, and BBI MRI.

To pharmacologically induce migraine headache in the study subjects, the investigators will use the drug cilostazol, which is a phosphodiesterase 3 inhibitor.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Written informed consent
  • Subject has migraine without aura according to criteria of the International Headache Society (IHS)
  • Subject has unilateral migraine 70% of the time
  • Migraine can be pharmacologically provoked in the subject using cilostazol.
  • Subject is on birth control
  • Subject has no other medical history

Exclusion criteria

  • Subject suffers from bilateral migraine
  • Subject suffers from migraine with aura
  • Subject suffers from other primary headaches as specified by IHS criteria
  • Pregnant or breast feeding subjects
  • Subjects with contraindications for undergoing MRI scans
  • Any known drug allergy
  • Any signs or disorders of iron overload, including but not limited to hemosiderosis and porphyria cutanea tarda

Treatment and study plan

Feraheme

Drug

Feraheme is an USPIO agent, which will be applied as a contrast agent to visualize vascular inflammation in unilateral migraine without aura.

Other names: Ferumoxytol

Cilostazol

Drug

Cilostazol will be applied to provoke migraine attacks in migraineurs

Other names: Pletal

USPIO-MRI

Other

USPIO-MRI scans will be performed in order to assess possible vascular inflammation associated with migraine attacks.

BBI-MRI

Other

Black blood MRI scans will be performed in order to asses changes in vessel wall thickness due to possible vascular inflammation associated with migraine attacks.

Primary outcomes

  1. Change in USPIO uptake during attacks of unilateral migraine without aura compared to baseline

    Time frame: 34 hours

    On the first study day, migraine is induced with cilostazol, and intravenous infusion of Feraheme (USPIO) is delivered. On the second study day, USPIO-MRI is performed.

  2. Change in arterial wall thickness during attacks of unilateral migraine without aura compared to baseline

    Time frame: 6 hours

    On the first study day, migraine is induced with cilostazol, and 4 hours after cilostazol ingestion, BBI-MRI is performed.

  3. Change in arterial circumference as a proxy measure for vascular inflammation during attacks of unilateral migraine without aura compared to baseline

    Time frame: 34 hours

    On the first study day, migraine is induced with cilostazol, and at 4 hours and 28 hours after cilostazol ingestion, MR angiography is performed.

  4. Change in USPIO uptake during attacks of unilateral migraine without aura before and after sumatriptan

    Time frame: 36 hours

    On the first study day, migraine is induced with cilostazol and subsequently treated with sumatriptan. Intravenous infusion of Feraheme (USPIO) is delivered, and on the second study day, USPIO-MRI is performed.

  5. Change in arterial wall thickness during attacks of unilateral migraine without aura before and after sumatriptan

    Time frame: 7 hours

    On the first study day, migraine is induced with cilostazol, and 4 hours after cilostazol ingestion, BBI-MRI is performed. Subjects are treated with sumatriptan, and BBI-MRI is repeated.

  6. Change in arterial circumference as a proxy measure for vascular inflammation during unilateral attacks of migraine without aura before and after sumatriptan

    Time frame: 36 hours

    On the first study day, migraine is induced with cilostazol, and 4 hours after cilostazol, MR angiography is performed. Subjects are treated with sumatriptan, and MR angiography is repeated. 28 hours after cilostazol ingestion, MR angiography is performed again.

Sponsors and collaborators

Lead sponsor

Danish Headache Center

Other

Registry information

Official study title

Investigation of Vascular Inflammation in Migraine Without Aura Using Molecular Nano-imaging and Black Blood Imaging MRI

Important dates

Study start
2015
Primary completion
2018
Study completion
2018
First posted
Sep 15, 2015
Registry last updated
Jul 27, 2022

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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