Hypersensitivity to Phosphodiesterase 5 Inhibition in Post-Traumatic Headache

Study Overview
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Brief Summary
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To investigate whether sildenafil (phosphodiesterase 5 inhibitor) induces migraine-like headache in people with persistent post-traumatic headache (PTH) attributed to mild traumatic brain injury (mTBI).

Official Title
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Hypersensitivity to Phosphodiesterase 5 Inhibition in Post-Traumatic Headache: A Randomized Clinical Trial

Conditions
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Post-Traumatic Headache

Intervention / Treatment
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* Drug: Sildenafil
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18 to 65 years of age upon entry into screening History of persistent headache attributed to mild traumatic injury to the head for ≥ 12 months and in accordance with the International Classification of Headache Disorders, 3rd Edition (ICHD-3) ≥ 4 monthly headache days on average across the 3 months prior to screening Provision of informed consent prior to initiation of any study-specific activities/procedures Exclusion Criteria: > 1 mild traumatic injury to the head History of any primary or secondary headache disorder prior to mild traumatic injury to the head (except for infrequent episodic tension-type headache) History of moderate or severe injury to the head History of whiplash injury History of craniotomy History or evidence of any other clinically significant disorder, condition or disease (except for those outlined above) than, in the opinion of the site investigator, would pose a risk to subject safety or interfere with study evaluation, procedures or completion The subject is at risk of self-harm or harm to others as evidenced by past suicidal behavior Female subjects of childbearing potential with a positive pregnancy test during any study visit Cardiovascular disease of any kind, including cerebrovascular diseases Hypertension (systolic blood pressure of ≥150 mmHg and/or diastolic blood pressure of ≥100 mmHg) prior to the start of infusion on the experimental day Hypotension (systolic blood pressure of ≤90 mmHg and/or diastolic blood pressure of ≤50 mmHg) Initiation, discontinuation, or change of dosing of prophylactic medications within 2 months prior to study inclusion Intake of acute medications (e.g. analgesics, triptans) within 48 hours of infusion start Baseline headache intensity of >3 on an 11-point numeric rating scale (0 being no headache, 10 being the worst imaginable headache) Baseline headache with migraine-like features or self-reported baseline headache that mimics the subjects' usual headache with migraine-like features

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Sildenafil<br>Oral administration of 100 mg sildenafil. | Drug: Sildenafil<br>* Study participants will be allocated to receive oral administration of 100 mg sildenafil.<br>|
| Placebo Comparator: Placebo<br> | Drug: Placebo<br>* Study participants will be allocated to receive oral administration of placebo.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of Migraine-Like Headache | Difference in incidence of headache with migraine-like features (0 to 12 hours) between sildenafil and placebo. | 12 Hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Headache Intensity Scores | Difference in area under the curve (AUC) for headache intensity scores (0 to 12 hours) between sildenafil and placebo. | 12 Hours |