Intra-arterial Sphenopalatine Ganglion Block for Patients With Refractory Headache
试验速览
- 阶段
- 1 期
- 状态
- 撤回
- 试验地点
- 1
- 主要终点
- Number of Procedure-Related Adverse Events
研究概览
简要总结
The purpose of this study is to evaluate the safety and efficacy of intra-arterial (IA) delivery of Dexamethasone and Ketorolac into the arteries supplying the sphenopalatine ganglion (SPG) - a collection of neurons that plays an important role in headache disorders - in patients with refractory migraine, cluster headache and trigeminal neuralgia. All patients must fail standard treatments prior to enrollment in the trial.
详细描述
The investigators propose an outpatient, minimally invasive method to deliver Dexamethasone and Ketorolac to the SPG via the intra-arterial route. A microcatheter will be advanced via the radial (preferably) or the femoral artery (in case the radial approach is not feasible) using fluoroscopic guidance and standard interventional techniques, into the distal internal maxillary artery. This artery is a branch of the external carotid artery and supplies the territory of the sphenopalatine ganglion. The microcatheter will be advanced to the ostium of the distal small branches that supply the SPG (i.e. small arteries feeding the vasa nervosum). Once the microcatheter is in a good position, 15 mg Dexamethasone Sodium Phosphate and 15 mg of Ketorolac Tromethamine will be infused over 30 minutes.
The procedure will be performed with local anesthetic at the arterial puncture site. Conscious sedation will be used for anxious participants. After the procedure, the participant will be observed for 5 hours in ICU setting and then discharged to home.
The procedure will be performed unilaterally for participants with cluster headache and trigeminal neuralgia. The procedure could be performed bilaterally for participants with migraine.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Established diagnosis of one of the three following headache or facial pain disorders as defined by the ICHD-329 [chronic migraine, cluster headache, trigeminal neuralgia] and failure to respond to two or more preventive therapies
- •A. Chronic migraine
- •Failure to respond to two or more preventive therapies including Onabotulinumtoxin A, erenumab, fremanezumab, galcanezumab, topiramate, valproic acid, metoprolol, propranolol, timolol, atenolol, nadolol, amitriptyline, nortriptyline, venlafaxine, duloxetine.
- •This will include status migrainosus.
- •B. Cluster headache
- •Failure to respond to Verapamil, AND one other preventive treatment including Prednisone, Dexamethasone, galcanezumab, lithium, valproic acid, topiramate, external vagus nerve stimulation
- •C. Trigeminal neuralgia
- •Failure to respond to two or more preventive therapies, including: Oxcarbazepine or carbamazepine, and One of the following: gabapentin, pregabalin, baclofen, lamotrigine, phenytoin
排除标准
- •Patients with malignant neoplasm of the pterygopalatine fossa
- •Pregnancy, lactation
- •Severe allergic reaction to Dexamethasone
- •Severe allergic reaction to NSAID
- •Renal failure
- •Active systemic infection or fever
- •Known cerebral vascular disease
- •Drug or alcohol abuse
- •Opioid dependency (stable doses ok)
- •Triptans within 48 hours from the procedure
研究组 & 干预措施
Intra-Arterial Delivery of Ketorolac and Dexamethasone
干预措施: Ketorolac (Drug)
Intra-Arterial Delivery of Ketorolac and Dexamethasone
干预措施: Dexamethasone (Drug)
结局指标
主要结局
Number of Procedure-Related Adverse Events
时间窗: 2 weeks post procedure
次要结局
- Change in Number of Days of Headache in Subjects with Chronic Migraine(1 week, 2 weeks, 4 weeks, 6 weeks)
- Proportion of Chronic Migraine Patients that achieve at least 50% reduction in days of headache frequency(1 week, 2 weeks, 4 weeks, 6 weeks)
- Proportion of patients with Cluster Headache that achieve 50% reduction in median number of attacks per day(1 week, 2 weeks, 4 weeks, 6 weeks)
- Change in number of days of facial pain for subjects with trigeminal neuralgia(1 week, 2 weeks, 4 weeks, 6 weeks)
- Proportion of patients with trigeminal neuralgia that achieve at least 50% reduction in days of facial pain frequency(1 week, 2 weeks, 4 weeks, 6 weeks)