Eary Infusion of Eptinezumab for TreatmEnt of ACute Post-Traumatic Headaches (ELITE-ACT)

What this study is about

Most individuals with mild traumatic brain injury (mTBI) experience post-traumatic headaches (PTH). Of PTH, 50% present with a migraine phenotype which is the most disabling type of PTH. Patients with migraine-PTH are at greater risk of persistent symptoms whereby the acute PTH (aPTH) becomes persistent PTH (pPTH) (ie. lasting \> 3 months) with a conversion rate of 47-95%. As migraine symptoms become chronic, it becomes treatment resistant. Despite these implications, early preventive medication management of PTH is marred by lengthy trials of multiple medications (2-3 months for each) and adverse effects that aggravate mTBI symptoms (fatigue, nausea, and presyncope). There is a compelling need to establish an effective treatment to prevent this debilitating outcome. Eptinezumab is a calcitonin gene-related peptide (CGRP)-blocking monoclonal antibody that reduces migraine burden in patients with migraines after a single infusion. Patients with PTH have higher serum levels of CGRP and experimental infusion of CGRP to patients with mTBI reproduces migraine PTH symptoms. Given the similarly in CGRP expression between chronic migraines and PTH, an infusion of eptinezumab within 8 weeks of PTH is hypothesized to reduce headache burden 3 months after treatment and prevent pPTH.

Who can join (things the study team will check)

✅ You may be able to join if…

• Meet diagnostic criteria for acute post-traumatic headache as per ICHD-3 criteria
• Meet migraine screening questionnaire criteria (MSQ score ≥ 4) during at least one of the weekly screening calls
• Within 8 weeks after onset of PTH
  • Imaging is not required for inclusion
• Negative human chorionic gonadotropin test before treatment, for female participants of childbearing potential who are not practicing medically appropriate methods of birth control (e.g., hormonal contraceptives, implants, injectables, intrauterine devices, intrauterine systems, etc.)

🚫 You may not be able to join if…

• Diagnosis of moderate to severe TBI
• History of mTBI within the past 5 years
• Pre-existing chronic migraine and its subtypes, tension-type headache, trigeminal autonomic cephalalgias, cranial neuralgias, daily headache, diagnosis of another secondary headache disorder per ICHD-3 (except medication overuse headache)
• Concurrent use of CGRP-related treatment or botulinum toxin within the last three month for migraine
• Substance / opioids use disorder
• Confounding chronic pain disorder / clinically significant pains
• Concurrent major injuries (long bone, rib, and spinal fractures) or surgical intervention while in hospital on initial trauma
• On-going litigation for current trauma
• Pregnancy/breast-feeding
• Uncontrolled psychiatric conditions (depression, PTSD, anxiety, functional neurological disorder)
• Use of opioids/barbiturates for headaches (> 4 days/month)
• Hereditary fructose intolerance

Where this trial is running

• Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Who to contact

Howard Meng, MD · 416-480-4864 · howard.meng@sunnybrook.ca

It's completely normal to call and ask questions before deciding anything. Mention the study ID: NCT07191145.