Study of Rizatriptan in the Treatment of Acute Attacks of Post-traumatic Headache in U.S. Military Troops

A Randomized, Double-blind, Placebo-controlled, Crossover Trial of Rizatriptan 10 mg Oral Disintegrating Tablet for Treatment of Acute Attacks of Chronic, Blast-induced, Post-traumatic Headache in U.S. Military Troops

The purpose of the study is to determine the effectiveness of rizatriptan for treating attacks of chronic post-traumatic headache.

Chronic post-traumatic headaches develop in about one third of soliders who have had head trauma caused by a blast. A wide variety of pain medicines, including rizatriptan, are used to treat these headaches in clinical practice. However, the effectiveness has not been established by clinical research studies.

Inclusion Criteria:

1. U.S. Army soldier with history of concussion while deployed to a combat zone. Concussion is defined as head trauma with all of the following:

2. No loss of consciousness or loss of consciousness less than 30 minutes.

3. Glasgow Coma Score 13-15 (if known)

4. Symptoms or signs of concussion.

5. Concussion was secondary to primary, secondary, or tertiary blast injury.

6. Headaches started within 7 days of concussion.

7. Headaches have occurred for more than 3 months but not more than 24 months since the precipitating concussion.

8. Headaches occurred 3 to 14 days per month during each of the previous two months.

9. Headaches are migraine type and possess three or more of the following migraine features:

10. moderate or severe pain

11. throbbing or pulsatile pain

12. unilateral or asymmetric pain

13. pain exacerbated by or interfering with routine physical activity

14. nausea or vomiting

15. photosensitivity and phonosensitivity

16. Headaches last 4 or more hours without treatment.

17. Males 18 to 49 years of age.

18. Migraine Disability Assessment Score (MIDAS) greater than 10 or Headache Impact Test-6 (HIT6) score greater than 60.

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Exclusion Criteria:

1. Patients with a history of migraine headaches prior to concussion will be excluded.
2. Prior use of any triptan medication for headache.
3. Use of non-opioid analgesic medications 15 or more days per month for the previous month.
4. Use of opioid medications more than 10 days in the previous month.
5. Alcohol consumption of more than two servings (a serving is 2 oz hard liquor, 5 oz wine, or 12 oz beer) per day or more than 3 servings at one time on a weekly basis.
6. Taking two or more medications from the following medication classes: SSRI, SNRI, or TCA.
7. Headache prophylactic medication is allowed but must remain unchanged during the study period.
8. Patients with depression, defined as a PHQ-9 score greater than 15, will be excluded from study participation.
9. PTSD is NOT an exclusion criterion. PTSD will be defined as a clinical diagnosis by a behavioral health provider or PTSD symptom checklist score of 50 or higher.
10. Systolic BP > 140 or diastolic BP > 90 on repeated measurements.
11. Active use of dihydroergotamine.
12. Known coronary artery disease, prior myocardial infarction, history of stroke or TIA, or liver disease.
13. Subjects who will not be available for study-related follow-up visits will be excluded.
14. Patient has cognitive impairment defined as mini-mental status exam score less than 27.
15. Patients undergoing a medical board for headache, sequelae of TBI, or psychiatric disorders will be excluded.
16. Patients suspected of malingering, exaggerating symptoms, or non-compliance will be excluded from study participation.
17. Patient has hemiplegic migraine or basilar migraine.