Mental imagery and symptom worsening in people with persistent post-concussive symptoms

Characterization of Headache and Dizziness Exacerbation Following Mental Imagery in Patients With Persistent Post-Concussive Symptoms

This project will try short guided mental-imagery exercises to see if they trigger or worsen headaches, dizziness, or other ongoing symptoms in people with persistent post-concussive symptoms after a mild TBI.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 60 (estimated)
• Ages: 18 Years to 70 Years
• Sex: All
• Sponsor: Reuth Rehabilitation Hospital (other)
• Locations: 1 site (Tel Aviv)
• Trial ID: NCT07166536 on ClinicalTrials.gov

What this trial studies

This interventional protocol recruits adults treated at Reuth Rehabilitation Hospital who have ongoing symptoms after a mild traumatic brain injury. Participants will have medical-record data collected and complete baseline clinical and cognitive screenings. They will then perform guided mental-imagery provocation tasks while symptom intensity (for example headache and dizziness) is recorded before, during, and after the tasks. The goal is to determine whether mental imagery can provoke symptoms and to shed light on perceptual or psychological mechanisms that may sustain persistent post-concussive symptoms.

Who should consider this trial

Good fit: Adults who are current patients or were discharged from Reuth Rehabilitation Hospital within the past 12 months, sustained a mild TBI at least 3 months earlier, have persistent post-injury headaches and/or dizziness, and can provide informed consent.

Not a fit: People with major central neurological disorders, unresolved alternative medical causes of headache, or significant cognitive impairment that prevents informed consent are unlikely to benefit from the provocation testing.

Why it matters

Potential benefit: If successful, this work could reveal psychological mechanisms that sustain long-term post-concussive symptoms and point to new targets for treatments to reduce headaches and dizziness.

How similar studies have performed: Mental imagery has been shown to provoke symptoms in some other chronic somatic conditions, but this specific mental-imagery provocation approach has not been previously tested in persistent post-concussive symptoms.

Eligibility criteria

Inclusion Criteria:

1. Current patients of Reut Rehabilitation Hospital or individuals who were discharged from the hospital within the past 12 months.
2. Diagnosis of mild Traumatic Brain Injury, concussion, blast injury, or cervical whiplash injury.
3. More than 3 months since the event.
4. Presence of headaches and/or dizziness that began after the injury and have persisted continuously or intermittently.
5. Exclusion of other potential causes of headaches, such as non-healed fractures, chronic inflammation/infection, increased intracranial pressure, or meningeal injury.
6. Headache intensity of at least 3/10 on the VAS scale.

Exclusion Criteria:

1. Significant cognitive impairment preventing informed consent (Mini-Mental State Examination score \<20 or Montreal Cognitive Assessment score \<20, as per IRB requirements).
2. Diagnosed central neurological conditions such as multiple sclerosis, Parkinson's disease, stroke, or brain tumor.
3. Presence of known pyramidal or extrapyramidal neurological signs.
4. Significant language impairment interfering with communication.
5. Psychiatric disorders significantly affecting communication.
6. Use of vestibular-suppressant medication (e.g., Cinnarizine) with an inability or unwillingness to discontinue treatment 24 hours prior to testing.

Withdrawal Criteria:

1\. Oculomotor dysfunction affecting multiple oculomotor functions.

Where this trial is running

Tel Aviv

• Reuth Rehabilitation Hospital — Tel Aviv, Israel (RECRUITING)

Study contacts

• Principal investigator: Keren Sivan-Speier, MD — Reuth Rehabilitation Hospital
• Study coordinator: Yotam Yanai, BPT

Conditions: Mild Traumatic Brain Injury, Concussion, Post Concussive Syndrome, Chronic, Post Traumatic Headache, mild traumatic brain injury, Persistent Post-Concussion Symptoms, mental imagery, concussion