Comparison of Ketorolac Nasal Spray to Sumatriptan Nasal Spray and Placebo for Acute Treatment of Migraine
Condition: Migraines
MeSH terms: Migraine Disorders
Intervention: Ketorolac; Sumatriptan; Placebo
Intervention description: Single dose of Ketorolac (Sprix) nasal spray 31.5 mg, one spray in each nostril for an acute migraine attack.; Sumatriptan (Imitrex) 20 mg one single dose of nasal spray for an acute migraine attack.; Placebo one spray in each nostril and placebo one nasal spray.
Intervention MeSH terms: Ketorolac; Sumatriptan
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Double (Participant, Investigator)
Enrollment: 72.0
Sex: All
Minimum age: 18 Years
Maximum age: 65 Years
Healthy volunteers: No

Summary:

      The investigators propose to test the efficacy of ketorolac nasal spray versus sumatriptan
      nasal spray versus placebo for acute abortive therapy of migraine head pain as well as for
      migraine associated symptoms including nausea and allodynia.
    

Eligibility criteria:

        Inclusion/Exclusion Criteria

        At the Screening Visit, a subject must meet the following criteria to participate in this
        study:

        1.18-65 years of age 2.Fulfills International Classification of Headache Disorders
        (ICHD)-II Criteria of migraine as noted below in Table 1 3.History of migraines for at
        least one year 4.Migraine onset prior to the age of 50 years of age 5.Headache frequency
        (of any headaches, migraine or non-migraine) < 9 days per month 6.At visit 2, participants
        must report two or more headache days during the 28-day run-in period on the headache
        diary. 7.At least 48 hours of freedom from headache between treated migraine attacks. 8.If
        currently using headache preventive medications, must be on a stable dose for at least 3
        months prior to enrollment and throughout the study period and be on no more than one
        prophylactic agent. 9.Able to complete all study procedures, including the questionnaire
        (assessing demographics, headache characteristics, headache comorbidities and medical
        history at the initial visit and headache characteristics) and the required headache
        calendars, and all study visits; 10.Able to understand, read and sign an informed consent
        (English).

        Exclusion Criteria:

          1. Any condition (history or presence of) which contraindicates the use of triptans or
             NSAIDs including:

               -  Known hypersensitivity or intolerance to triptans or NSAIDs

               -  Contraindications to triptan use (uncontrolled hypertension, ischemic heart
                  disease, prinz-metal angina, cardiac arrhythmias, multiple risk factors for
                  atherosclerotic vascular disease, primary vasculopathies, and basilar and
                  hemiplegic migraine)

               -  Cerebrovascular disease except for mild non-specific white matter disease

               -  Peripheral vascular disease or any other ischemic disease including myocardial
                  infarction

               -  Uncontrolled hypertension (systolic BP 160 mmHg or diastolic BP 95 mmHg or (both)

               -  Migraine aura fulfilling ICHD-II criteria for hemiplegic or basilar-type migraine

               -  Any history of chronic renal or hepatic impairment

               -  Use of an ergotamine-containing medication or monamine oxidase inhibitor

               -  Known or suspected pregnancy, negative pregnancy test

               -  Lactation

               -  Bleeding dsycrasias including gastritis, peptic ulcer disease,gastrointestinal
                  bleeding

          2. Physician diagnosis of any pain syndrome other than migraine

          3. Classification as treatment resistant by investigator

          4. Known drug or substance abuse

          5. Any opioid use in past 2 months

          6. Use of any medication, which could interfere with study assessments

          7. History of noncompliance with taking medication;

          8. Use of any experimental drug or device within 30 days prior to the Screening Visit
             (Visit 1);

          9. Any abnormal finding or condition deemed clinically significant by the investigator on
             history, screening, or physical exam that contraindicates the use of triptans or
             NSAIDs or that might interfere with the patient's safety, study participation, or
             which might confound the interpretation of the study results.

         10. Any history of chronic renal or hepatic disease already excluded above under number 1;
             plus see exclusion 9.

         11. History of chronic pulmonary disorder including nasal polyps (see 1) and asthma.

         12. History of upper respiratory infection or other respiratory tract condition that could
             interfere with the absorption of the nasal spray or with assessment of AEs including
             rhinitis medicamentosa (chronic daily use of topical decongestants).

         13. History of nasal surgery.