Subjects enrolled into this 10 week study will for the first two weeks document the number of cluster headaches and the means of treating (medication) of these attacks. Subjects will then be randomized to into either two groups. The first group is continuing with standard of care and the second group is treatment with the investigational device (GammaCore) for a period of 4 weeks. After this 4 week period, all subjects will treat with the GammaCore for another 4 week period. It is hypothesized the the treatment group will have a reduction in mean cluster headaches per week by 50% compared to the standard of care group.
The study is a prospective randomized controlled multi-center investigation designed for comparison of two parallel groups, GammaCore® (active treatment) and Standard of Care, SoC, (control). The study period begins with a 2 week run-in period, followed by a 4 week comparative period when the subjects are randomized to either active treatment or control 1:1. The comparative period will be followed by a period where all subject will receive GammaCore® for 4 weeks.After the subject signed the Consent Form for participation the baseline (visit1) data will be collected. Subject will be informed how to complete the 2 week diary during the run-in period During the run-in period, all subjects will use stable SoC according to their individual prescriptions. The subject will record as CH attack regarding duration and frequency and the use of medication and oxygen. Once subjects have finalized the run-in period, they are randomized to continue in 4 weeks comparative period. During this period, the control group continues with stable SoC and the active group is provided with a GammaCore® device for prophylactic and acute treatment in addition to the stable SoC Subjects stimulate 3 x 2 times daily as part of the prophylactic treatment regimen (cervical vagal nerve). Three 90 second stimulations are self-administered by the subject with 5 minutes between each stimulation on the right side of the neck. This preventive stimulation regimen is performed: * First Daily Treatment - within 1 hour of waking * Second Daily Treatment - 7-10 hours following the first daily treatment Acute CH attack: * 3 x 90 second treatments consecutively at the onset of pain or symptoms. If the attack is not aborted within 15 minutes the subject should be informed to take SOC abortive medication. * If an acute cluster headache attack is treated with the GammaCore® device, the subject will try to work within the preventive treatment window to avoid a preventive treatment in the 2-hour refractory period following the acute treatment. A total of minimally 6 stimulations for the preventive part and as needed for the acute attacks. The active group also continues with the stable SoC during the entire 4 weeks period. Both groups record all CH attacks in the diary together with medication and oxygen use. All adverse events shall also be recorded in the diary. The end of the 4 week comparative period marks the completion of the randomized part of the study, however all subjects are provided the option to continue to a 4 week GammaCore® treatment with the same stimulation parameter as during the 4 week randomization period. All subjects randomized to the SoC group will receive training. During the entire study period, subjects are allowed to take rescue medication including oxygen inhalation for abortion of CH attacks. The amount and doses of the medication and oxygen are recorded in the diary.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
97
vagal stimulation
University Department of Neurology CHR
Liège, Liège, Belgium
Krankenhaus Lindenbrunn, Department of Neurology
Coppenbrügge, Coppenbrügge, Germany
Westdeutsches Kopfschmerzzentrum
Hufelandstr. 26, Hesse, Germany
Migräne- und Kopfschmerzklinik Königstein
Königstein im Taunus, Königstein Im Taunus, Germany
Department of Neurology, University of Munich
Munich, Munich, Germany
Neurologische Klinik und Poliklinik
Berlin, State of Berlin, Germany
Regional Referral Headache Centre Sant' Andrea Hospital
Rome, Rome, Italy
The Southern Hospital, Neurology Department
Glasgow, Scotland, United Kingdom
Hull Royal Infirmary, Neurology Department
Hull, United Kingdom
The Walton Centre, Neurology Department
Liverpool, United Kingdom
A Change in the Frequency of Cluster Headache Attacks Per Week
The primary endpoint is the reduction in mean number of CH attacks per week. The number of CH attacks will be calculated as the sum of all attacks over the days in the run-in period and divided by the number of weeks, respectively for the last 14 days of treatment during the randomised phase. The reduction will then be the number of CH attacks during treatment period (last 14 days of the randomized treatment period) - number of CH attacks during run-in.
Time frame: 4 weeks
Pain Relief of Headache Attacks
The median pain during baseline (2 weeks) will be compared with the last 14 days of the treatment period Scale 0-4 0= no pain 1. mild pain 2. moderate pain 3. severe pain 4. very severe pain
Time frame: baseline (2 weeks) and random period(last 2 weeks)
Adverse Events
The frequency of device effects will be compared between the two treatment groups. Only effects which are new after baseline or have increased severity after baseline will be used in the comparison.
Time frame: 10 weeks
EQ-5D-3L (EuroQoL 5 Questions and 3 Answering Levels) and a VAS (Visual Analogue Scale)
The EQ-5D-3L (EuroQoL 5 questions and 3 answering levels) during the run-in period will be compared with the EQ-5D-3L during the treatment period. And treatment period will be compared to open label. Rating of questions Level 1 no problems Level 2 some problems Level 3 Significant problems Worst case is 15 points and best case is 5 points using index Visual analogue scale VAS 0-100 where 0 is the worst imaginable health state and 100 the best imaginable health state
Time frame: 10 weeks (baseline 2 weeks, random 4 weeks and open label 4 weeks)
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