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Substance P is a signaling molecule that has been implicated in the pathogenesis of headache. This study aims to ascertain whether administration of substance P can induce headache in healthy adults.
Substance P is a vasoactive signaling molecule that belongs to the tachykinin family of peptides. It is expressed in multiple cells, including primary afferents of the trigeminal ganglion that innervate the meninges and its arteries. The best-known function of substance P is its role in pain transmission, and several lines of evidence has implicated substance P in the pathogenesis of headache. This study aims to ascertain whether intravenous infusion of substance P induces headache in healthy individuals who have no past or current history of primary or secondary headache disorder, except for infrequent episodic tension-type headache. For this purpose, we will conduct a randomized, double-blind, placebo-controlled, 2-way crossover trial.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Substance P | Experimental | Substance P will be administered by intravenous infusion. |
|
| Placebo | Placebo Comparator | Placebo (isotonic saline) will be administered by intravenous infusion. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Substance P | Drug | The participants will receive a continuous intravenous infusion of 20 mL of substance P (1.5 pmol/kg/min) over 20 minutes. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of Headache | The primary outcome is the difference in the incidence of headache* between substance P and placebo during the 12-hour observational period after infusion start. * The intensity of headache is rated by the subject on the 11-point numerical rating scale (0 being no headache, 10 being the worst imaginable headache). | 12 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Headache Intensity Scores | The secondary outcome is the difference in the area under the curve for median headache intensity scores between substance P and placebo during the 12-hour observational period after infusion start. | 12 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Dilation of the Superficial Temporal Artery | The difference in area under the curve for relative STA dilation between substance P and placebo from the start of infusion to 2 hours after the infusion. | 2 hours |
| Blood Flow Velocity in the Middle Cerebral Artery |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Hakan Ashina, MD, PhD | Contact | +45 28 10 24 95 | haakan.ashina@regionh.dk | |
| Haidar Al-Khazali, MD | Contact | +45 41 59 84 94 | haidardk@hotmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Danish Headache Center, Copenhagen University Hospital - Rigshospitalet | Glostrup Municipality | 2600 | Denmark |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40369974 | Derived | Al-Khazali HM, Christensen RH, Gozalov E, Hakimzadeh Z, Melchior AG, Dominguez-Moreno R, Ashina M, Ashina H. Effects of substance P on headache induction and arterial dilation in healthy adults. Cephalalgia. 2025 May;45(5):3331024251336132. doi: 10.1177/03331024251336132. Epub 2025 May 14. |
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Anonymized data not published within this article will be made available on reasonable request from any qualified investigator.
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| ID | Term |
|---|---|
| D006261 | Headache |
| ID | Term |
|---|---|
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D013373 | Substance P |
| ID | Term |
|---|---|
| D015320 | Tachykinins |
| D007705 | Kinins |
| D036341 | Intercellular Signaling Peptides and Proteins |
| D010455 | Peptides |
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The present trial has a randomized, double-blind, placebo-controlled, 2-way crossover design and will be conducted at a single site.
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| Placebo | Drug | The participants will receive a continuous intravenous infusion of 20 mL of placebo (isotonic saline) over 20 minutes. |
|
The difference in area under the curve for change in MCA mean blood flow velocity between substance P and placebo from the start of infusion to 2 hours after the infusion. |
| 2 hours |
| D000602 |
| Amino Acids, Peptides, and Proteins |
| D009479 | Neuropeptides |
| D009842 | Oligopeptides |
| D011506 | Proteins |
| D009419 | Nerve Tissue Proteins |
| D012898 | Autacoids |
| D018836 | Inflammation Mediators |
| D001685 | Biological Factors |