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This study aims to explore the effect of Ivabradine on Levcromakalim-induced migraine in individuals with migraine without aura.
Hyperpolarization-activated cation (HCN) channels have recently been implicated in neuropathic and inflammatory pain processes through their hyperfunction and/or overexpression.
HCN channels may play a significant role in migraine pathophysiology, as 1) both an inflammatory and a neuropathic component has been hypothesized to contribute to migraine, and 2) HCN channel activity is facilitated by cyclic nucleotides, e.g. cAMP and cGMP (molecules thought to be central in migraine pathophysiology) and increases in extracellular K+ concentration.
Opening of adenosine 5'-triphosphate-sensitive potassium channels (KATP channels) using Levcromakalim causes migraine attacks with and without aura in a high proportion of patients. KATP channel activation leads to hyperpolarization, which in turn could increase the open probability of HCN channels.
This study aims to explore the effects of Ivabradine on Levcromakalim-induced migraine in individuals with migraine without aura.
The investigators anticipate that this project will contribute greatly to the current understanding of migraine pathophysiology and the hypothesized role of HCN channels in migraine pain mechanisms. This is of great interest in future research, as such knowledge is an important prerequisite for further investigation and understanding of intracellular signalling mechanisms in migraine, which in turn will lead to the development of more effective and mechanism-based drugs.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Levcromakalim - Ivabradine | Active Comparator | Infusion of levcromakalim (2.5 nmol minutes-1 over 20 minutes) followed by oral administration of ivabradine (15 mg orally). |
|
| Levcromakalim - Placebo | Placebo Comparator | Infusion of levcromakalim (2.5 nmol minutes-1 over 20 minutes) followed by oral administration of placebo. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Levcromakalim | Drug | 20 min infusion of 1 mg Levcromakalim followed by either oral Ivabradine or Placebo. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of migraine attacks | A migraine attack is defined as an attack fulfilling either (i) or (ii): (i) Headache fulfilling criteria C and D for migraine without aura according to the International Headache Society criteria: C. Headache has at least two of the following characteristics:
D. During headache at least one of the following:
(ii) Headache described as mimicking the patient's usual migraine attack and treated with acute migraine medication (rescue medication). | Assessed from baseline to 12 hours after infusion of levcromakalim |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of headache | Incidence of headache is defined as headache intensity ≥1 as measured by a numerical rating scale (NRS) from 0 to 10. It is a verbally declared scale from 0 to 10, where 0 is no pain; 10 is the worst pain imaginable | Assessed from baseline to 12 hours after infusion of levcromakalim |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Messoud Ashina, Prof. | Danish Headache Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Danish Headache Centre, Rigshospitalet-Glostrup | Glostrup | Region Sjælland | 2600 | Denmark | ||
| Danish Headache Center |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41930571 | Derived | Zhuang ZA, Thuraiaiyah J, Kokoti L, Moreno RD, Gozalov E, Hakimzadeh Z, Al-Karagholi MA, Clement A, Kristensen DM, Abdulla J, Christensen SL, Ashina M. Migraine induced by vascular KATP channel activation is independent of HCN channel activity: A randomised controlled trial with translational validation. Cephalalgia. 2026 Apr;46(4):3331024261431770. doi: 10.1177/03331024261431770. Epub 2026 Apr 3. |
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| ID | Term |
|---|---|
| D006261 | Headache |
| D020326 | Migraine without Aura |
| ID | Term |
|---|---|
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D019806 | Cromakalim |
| D000077550 | Ivabradine |
| ID | Term |
|---|---|
| D011758 | Pyrroles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
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| Ivabradine | Drug | 15 mg oral Ivabradine. |
|
| Placebo | Drug | Oral placebo (calcium supplements). |
|
| Intensity of headache |
Headache intensity scores are measured by a numerical rating scale (NRS). It is a verbally declared scale from 0 to 10, where 0 is no pain; 10 is the worst pain imaginable. |
| Assessed from baseline to 12 hours after infusion of levcromakalim |
| Changes in cerebral hemodynamics (velocity of blood flow in middle cerebral artery and diameter of superficial temporal artery) assessed using Transcranial Doppler Ultrasound (TCD) and high-frequency ultrasound (Dermascan C, Cortex Technology, Denmark) | Changes in cerebral hemodynamics will be assessed using Transcranial Doppler Ultrasound (TCD) (2 Mhz, DWL) to measure the velocity of middle cerebral artery (VMCA) blood flow bilaterally, and high-frequency ultrasound (Dermascan C, Cortex Technology, Denmark) to measure the diameter of the superficial temporal artery (STA) bilaterally. | Assessed from baseline until 150 minutes after levcromakalim infusion. |
| Changes in blood pressure | Changes in blood pressure (systolic and diastolic) over time. | Assessed from baseline until 150 minutes after levcromakalim infusion. |
| Heart rate | Changes in heart rate over time. | Assessed from baseline until 150 minutes after levcromakalim infusion. |
| Incidence of adverse events | Participants are instructed to inform the investigators in the case of adverse events. | Assessed from baseline to 12 hours after infusion of Levcromakalim. |
| Glostrup Municipality |
| 2600 |
| Denmark |
| D008881 | Migraine Disorders |
| D051270 | Headache Disorders, Primary |
| D020773 | Headache Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D001578 |
| Benzopyrans |
| D011714 | Pyrans |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D001552 | Benzazepines |