Embolization of the middle meningeal artery for chronic resistant migraine treatment

Study of the Effectiveness and Safety of Embolization of the Middle Meningeal Artery Using Non-adhesive Materials SQUID 12 and SQUID 18 in the Treatment of Patients With Chronic Resistant Migraine

This study is testing a new procedure to block a specific artery in the brain to see if it can help people with chronic migraines who haven't found relief from other treatments.

Quick facts

• Phase: Early Phase 1
• Study type: Interventional
• Enrollment: 30 (estimated)
• Ages: 35 Years to 59 Years
• Sex: All
• Sponsor: Vedanta University Clinic (Academic / other)
• Locations: 1 site (Bishkek, Bishkek)
• Trial ID: NCT06848166 on ClinicalTrials.gov

What this trial studies

This study evaluates the effectiveness and safety of embolizing the middle meningeal artery using non-adhesive materials, specifically SQUID 12 and SQUID 18, in patients suffering from chronic resistant migraines. The intervention aims to provide a novel treatment option for individuals who have not responded to traditional pharmacological and non-pharmacological therapies. Participants will be monitored for their migraine frequency and severity over a specified period to assess the outcomes of the procedure.

Who should consider this trial

Good fit: Ideal candidates for this study are adults aged 35 to 59 who have been diagnosed with chronic resistant migraines and have experienced headaches on at least 14 days within a 28-day period.

Not a fit: Patients who do not have chronic resistant migraines or those who have not tried other treatment options may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could significantly reduce the frequency and severity of chronic migraines in patients who have not found relief through other methods.

How similar studies have performed: While this approach is relatively novel, similar studies exploring embolization techniques for migraine treatment have shown promising results.

Eligibility criteria

Inclusion Criteria:

1. The patient has read, understood, signed, and dated the Patient Information Sheet with the informed consent form.
2. The patient is aged between 35 and 59 years inclusive at the time of signing the Patient Information Sheet with the informed consent form.
3. The diagnosis of "chronic migraine" according to the clinical guidelines on migraine by the Ministry of Health of the Russian Federation (2021) / ICD-10 (2018), established at least 12 months before screening.
4. Resistant nature of the migraine, determined by the doctor using the criteria of the European Headache Federation (EHF, 2020), established at least 6 months before screening.
5. At least 14 days of headache during the screening period (28 days), of which 8 days of headache meet the definition of migraine (assessed based on the results of filling out the Headache Diary for 28 days during the screening period).
6. Migraine, resistant to both pharmacological and non-pharmacological prevention and treatment methods, in the patient's history.
7. Maximum level of headache during migraine days above 5 points (inclusive) on a 10-point numerical rating scale during the screening period.
8. No positive effect on migraine symptoms (frequency and intensity of headache attacks) from previous botulinum toxin therapy (administration of OnabotulinumtoxinA, Relatox® (botulinum toxin type A - hemagglutinin complex 155 - 195 IU, administered every 12 weeks according to the PREEMPT protocol).
9. Consent to use adequate contraceptive methods\* and not serve as an egg/sperm donor from the time of signing the Patient Information Sheet with the informed consent form for participation in the study until the end of the study (for women with reproductive potential and men).

Exclusion Criteria:

1. The patient has contraindications to undergoing embolization of the middle meningeal artery based on the medical history, results of examinations, and laboratory tests conducted during screening.
2. Allergic reactions to contrast agents used during procedures before/during the embolization procedure and associated procedures.
3. The patient has a history of cerebral vascular malformations, arteriovenous malformations, brain aneurysms, brain tumors, hydrocephalus, arachnoiditis, cerebrospinal fluid circulation disorders, craniovertebral junction anomalies, platybasia, skull base deformities, severe traumatic brain injuries, stenosis, and occlusion of pre-cerebral arteries.
4. The patient has a history of skull base fractures and consequences of skull base fractures, history of neurosurgical operations.
5. A history of mental illness (including depression, confirmed by a psychiatrist during screening through the HADS questionnaire and Hamilton scale assessment), which, in the opinion of the psychiatrist, may affect the patient's ability to assess their condition, interfere with participation in the study, or impact the patient's safety during the study.
6. A history of hyperthyroidism or diabetes. The presence of other endocrine disorders in the patient's history that, in the doctor's opinion, could interfere with participation in the study or affect the evaluation of efficacy and/or safety.
7. History or data of drug addiction, alcoholism, or abuse of medications.
8. Medication-induced headache at the time of screening and within 3 months (12 weeks) prior to screening.
9. Other types of chronic headache in the patient's history within less than 12 months before screening, such as trigeminal autonomic cephalalgias (including cluster headaches, prolonged hemicrania), new daily persistent headaches, painful cranial neuropathies, retinal migraine, aura without headache, hemiplegic migraine, brainstem aura migraine, idiopathic intracranial hypertension without optic nerve edema, spontaneous intracranial hypertension, secondary headaches.
10. The patient is unable to distinguish a migraine headache from other types of headache.
11. The patient has migraine complications, such as status migrainosus, persistent aura without infarction, migraine infarction, migraine aura (as a trigger for epileptic seizures).
12. Body mass index (BMI) below 18.5 or above 39.9 kg/m².
13. The onset of migraine was diagnosed at an age older than 50 years.
14. The presence of metabolic syndrome or cachexia.
15. Severe cardiovascular diseases currently or in the past, including: chronic heart failure class III or IV (according to the New York Heart Association classification), clinically significant ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation), significant heart valve diseases, uncontrolled hypertension with systolic blood pressure \> 180 mm Hg and diastolic blood pressure \> 110 mm Hg, pulmonary embolism, or deep vein thrombosis.
16. Varicose veins of the lower limbs, history of lower limb vein thrombosis.
17. Ischemic heart disease, atherosclerosis of coronary vessels.
18. Stenotic atherosclerosis of brachiocephalic arteries in the patient's history.
19. Acute cerebrovascular accident or its consequences in the patient's history.
20. The patient is pregnant or plans to become pregnant within the next 3 months.
21. Atrial fibrillation, patent foramen ovale, anomalies of the interatrial septum, history of heart and coronary vessel surgeries.
22. Signs of blood clotting disorders in the patient's history and screening, history of antiphospholipid syndrome.
23. Use of anticoagulant drugs less than 5 days before the procedure.
24. Uncontrolled bronchial asthma, severe chronic obstructive pulmonary disease in the patient's history.
25. Renal insufficiency at screening based on the calculation of glomerular filtration rate (GFR) ≤ 60 mL/min, based on serum creatinine levels at screening, or a history of renal insufficiency.
26. History of liver insufficiency, elevated ALT and AST levels at screening.
27. History of generalized pain syndrome, fibromyalgia.
28. For women: use of combined oral contraceptives with a history of thrombosis of any localization.
29. History of epilepsy, epileptic syndrome, seizure disorders, neurological conditions other than the primary condition (migraine).
30. Presence of antibodies to HIV, hepatitis C virus, hepatitis B surface antigen (HbsAg), antibodies to T. Pallidum, or a history of HIV infection, hepatitis B, hepatitis C, or syphilis, either in the medical history or based on the results of serological blood tests at screening.
31. Malignant neoplasms within 5 years before screening, or current or suspected oncological disease.
32. Other serious, unstable, decompensated, or clinically significant medical or psychological conditions that, in the opinion of the doctor, may interfere with the patient's participation in the study or affect the evaluation of efficacy and/or safety.
33. Participation in other interventional clinical trials, including the study completion visit, within 30 days prior to the screening, or planning to participate in such studies during the current study. Participation in non-interventional registry or epidemiological studies is allowed.
34. The patient is unable to read or write, unwilling or unable to comply with the study protocol procedures; any other conditions that, in the opinion of the doctor, may prevent participation in the study, adherence to procedures, or contradict the patient's interests, as well as affect the study results.
35. Employees of the medical institution conducting the study or the sponsor company, their family members, or subjects in dependent relationships.

Where this trial is running

Bishkek, Bishkek

• Vedanta University Clinic — Bishkek, Bishkek, Kyrgyzstan (Recruiting)

Study contacts

• Principal investigator: Andrey S Petrov, MD, PhD — Vedanta Clinic
• Study coordinator: Andrey E Petrov, MD, PhD

Conditions Chronic Migraine Headache