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| Name | Class |
|---|---|
| Netherlands Brain Foundation | OTHER |
| Innovatiefonds Zorgverzekeraars | OTHER |
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Cluster headache is a very severe primary headache disorder. In episodic cluster headache, attacks occur in 'bouts' (clusters) lasting weeks to months. Management of cluster headache entails a combination of attack and prophylactic treatment. Current first choice prophylactic treatment (verapamil) has considerable side effects which can be serious and include possibly fatal cardiac arrhythmias; and it can take weeks to titrate to an effective dose. Evidence has emerged that local steroid injection of the greater occipital nerve (GON) may be effective in cluster headache, but this method has not been investigated as a first line prophylactic treatment in a large, well-documented group of episodic cluster headache patients who are still free of prophylactic medication and just entered a new cluster headache episode. As such, GON-injection has not yet found its way into current treatment protocols. The investigators plan to perform this multicentre double-blind randomized controlled trial to investigate whether GON-injection is efficacious as a first-line prophylactic treatment, aiming to remove the need for high doses of daily medication - such as verapamil - with associated side effects.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Placebo | Placebo Comparator | Injection of NaCl |
|
| Verum | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Methylprednisolone | Drug | Single GON injection with methylprednisolone |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Verapamil mean total dose | Difference in mean total dose of verapamil used during the study period | 12 week period |
| Measure | Description | Time Frame |
|---|---|---|
| Days to remission | Median number of days to remission (7 consecutive days without attack) | 12 weeks |
| Daily attacks | Mean number of attacks per day during the study period |
| Measure | Description | Time Frame |
|---|---|---|
| Use of attack medication | The total use of attack medication (stratified for oxygen and sumatriptan) | 12 weeks |
| Daily attack severity and duration | Mean number, severity (1-10) and duration of attack per day. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Rolf Fronczek, MD, PhD | LUMC | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Boerhaave Clinics | Amsterdam | North Holland | Netherlands | |||
| LUMC |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40990636 | Derived | Brandt RB, Mulleners WM, Couturier E, Carpay JA, Gerlach OHH, Niesters M, Haan J, van Zwet EW, Ferrari MD, Fronczek R. Greater occipital nerve injection with methylprednisolone as transitional therapy in episodic cluster headache: Results from an RCT. Cephalalgia. 2025 Sep;45(9):3331024251370324. doi: 10.1177/03331024251370324. Epub 2025 Sep 24. |
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All Data will be stored using Castor EDC. All hard copies will be stored in the individual centers. If requested, after study completion, data can be shared with de PIs in participating centers.
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| ID | Term |
|---|---|
| D003027 | Cluster Headache |
| ID | Term |
|---|---|
| D051303 | Trigeminal Autonomic Cephalalgias |
| D051270 | Headache Disorders, Primary |
| D020773 | Headache Disorders |
| D001927 | Brain Diseases |
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| ID | Term |
|---|---|
| D008775 | Methylprednisolone |
| ID | Term |
|---|---|
| D011239 | Prednisolone |
| D011246 | Pregnadienetriols |
| D011245 | Pregnadienes |
| D011278 | Pregnanes |
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| Placebo |
| Other |
Single GON-injection with NaCl |
|
| 12 weeks |
| Peak dose verapamil | Peak dose verapamil | 12 weeks |
| Preamature termination | Premature termination of study due to need for escape medication | 12 weeks |
| For the total study period and each of the three consecutive 4-week time periods |
| Attack-freedom | Percentage of patients that are attack-free at days 7, 14 and 28 | days 7, 14 and 28 |
| Non-cluster headache | Occurrence of 'non-cluster' headache (number of days and mean intensity per affected day) | 12 weeks |
| Adverse events | Percentage of subjects with adverse-events (stratified for type of side effect (AE, SAE, SUSAR)) | 12 weeks |
| Subjective feeling | Subjective feeling at days 7, 14 and 28 (visual analogue scale, VAS. Scale from 0 to 10 where 0 is worst imaginable and 10 best imaginable) | Days 7, 14 and 28 |
| Satisfaction score | Satisfaction score (7 point scale, 0 to 6. 0 is completely unsatisfied and 6 completely satisfied) | 12 weeks |
| Recommendation | Would the patient recommend this treatment to others | Days 7, 14 and 28 |
| Blinding participants | What treatment does the patient think he/she received (placebo/GON/uncertain) | Days 7, 14 and 28 |
| Blinding investigators | What treatment do the investigators think the patient has had | Days 7, 14 and 28 |
| Leiden |
| South Holland |
| Netherlands |
| Alrijne Ziekenhuis | Leiderdorp | South Holland | Netherlands |
| Tergooi Ziekenhuis | Blaricum | Netherlands |
| Zuyderland Medisch Centrum | Heerlen | Netherlands |
| Canisius-Wilhelmina Hospital | Nijmegen | Netherlands |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D013256 |
| Steroids |
| D000072473 | Fused-Ring Compounds |
| D011083 | Polycyclic Compounds |