Combined Transcranial Magnetic Stimulation and Therapy for MTBI Related Headaches

NCT ID: NCT05176392

Last Updated: 2024-11-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

240 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-01-01

Study Completion Date

2025-08-31

Brief Summary

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This study will assess the combined effectiveness of repetitive transcranial magnetic stimulation (rTMS) and telehealth based therapy in helping manage mild traumatic brain injury (mTBI) related headaches. The investigators hypothesize that active rTMS combined with telehealth therapy will provide marked reduction in mTBI related headaches and symptoms in comparison to their placebo counterparts.

Detailed Description

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This study will be enrolling a total of 240 veterans or active military over a 4 year period at the VA San Diego Healthcare System (VASDHS). Participants will be randomized into one of four groups:

Group A: active rTMS with telehealth headache management therapy Group B: active rTMS with telehealth headache education control Group C: sham rTMS with telehealth headache management therapy Group D: sham rTMS with telehealth headache education control

Individual participation will consist of 19 visits to the VASDHS and 11 telehealth sessions over the course of 6-7 months. The in person visits will be divided into the following phases:

1. PRE-TREATMENT ASSESSMENTS PHASE (weeks 1-2) which consists of Visit 1 (Screening Visit) and Visit 2 (Baseline Assessments with MRI scan);
2. INDUCTION TREATMENT PHASE (weeks 3-4) consists of Visits 3-12 (10 weekday neuronavigation guided rTMS sessions at \>24 and \<72 hours apart); and
3. POST-TREATMENT ASSESSMENTS AND MAINTENANCE TREATMENT PHASE (weeks 5-24) consists of 4 initial biweekly post-induction treatment assessments and maintenance treatments (Visits 13-16)) and two additional monthly post-induction assessments and maintenance treatments (Visits 17-18) and one final study visit (Visit 19).

Eight weekly telehealth therapy/education sessions will be conducted from week 3 to 10 with additional three bolster sessions at 4 weeks apart. During the baseline and follow up visits, assessments will be conducted to evaluate headaches, neurobehavioral symptoms, depressive symptoms, post-concussion symptoms, and quality of life.

Conditions

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TBI (Traumatic Brain Injury) Headache Depression

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Each participant will be randomized into one of 4 groups. Blocked randomization will be used with random block size of 4 or 8. Participants will be randomized to study groups in a 1:1:1:1 ratio.
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Investigators
The participant, study coordinators and the investigators will be blinded to the rTMS treatment. The participant will be blinded to the therapy group (headache management or headache education).

Study Groups

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Active rTMS with telehealth headache management therapy

Participants receive both active rTMS treatment at the left dorsolateral prefrontal cortex and therapy for headache management

Group Type ACTIVE_COMPARATOR

Active rTMS

Intervention Type DEVICE

Active rTMS will be given at the left dorsolateral prefrontal cortex with a double blind TMS coil.

Headache Management Therapy

Intervention Type BEHAVIORAL

Therapy will be provided on headache management.

Active rTMS with telehealth headache education control

Participants receive active rTMS treatment at the left dorsolateral prefrontal cortex and headache education

Group Type OTHER

Active rTMS

Intervention Type DEVICE

Active rTMS will be given at the left dorsolateral prefrontal cortex with a double blind TMS coil.

Headache Education Control

Intervention Type BEHAVIORAL

In the control, educational sessions on headaches will be provided.

Sham rTMS with telehealth headache management therapy

Participants receive sham rTMS treatment at the left dorsolateral prefrontal cortex and therapy for headache management

Group Type OTHER

Headache Management Therapy

Intervention Type BEHAVIORAL

Therapy will be provided on headache management.

Sham rTMS

Intervention Type DEVICE

Sham rTMS will be given at the left dorsolateral prefrontal cortex. All parameters of the treatment will appear identical to the active treatment, with only the rTMS coil used to administer the treatment flipped 180 degrees to prevent stimulation.

Sham rTMS with telehealth headache education control

Participants receive sham rTMS treatment at the left dorsolateral prefrontal cortex and headache education

Group Type SHAM_COMPARATOR

Sham rTMS

Intervention Type DEVICE

Sham rTMS will be given at the left dorsolateral prefrontal cortex. All parameters of the treatment will appear identical to the active treatment, with only the rTMS coil used to administer the treatment flipped 180 degrees to prevent stimulation.

Headache Education Control

Intervention Type BEHAVIORAL

In the control, educational sessions on headaches will be provided.

Interventions

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Active rTMS

Active rTMS will be given at the left dorsolateral prefrontal cortex with a double blind TMS coil.

Intervention Type DEVICE

Headache Management Therapy

Therapy will be provided on headache management.

Intervention Type BEHAVIORAL

Sham rTMS

Sham rTMS will be given at the left dorsolateral prefrontal cortex. All parameters of the treatment will appear identical to the active treatment, with only the rTMS coil used to administer the treatment flipped 180 degrees to prevent stimulation.

Intervention Type DEVICE

Headache Education Control

In the control, educational sessions on headaches will be provided.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

1. Mild Traumatic Brain Injury (mTBI)
2. Chronic headaches \> 3 months after injury
3. Aged 18-65
4. No prior TMS treatment
5. Persistent Headaches with an intensity \> 30 / 100
6. No history of daily headache prior to mTBI

Exclusion Criteria

1. Pregnant
2. Pacemaker or any metal in body that would prevent MRI
3. History of dementia or major psychiatric disease, such as bipolar disorder or schizophrenia
4. Presence of any other chronic neuropathic pain states
5. History of seizure
6. Pending litigation
7. Can't understand English
8. History of chronic headache like migraine prior to mTBI
9. Evidence in chart of exacerbation of depressive/anxiety symptoms, active substance dependence, suicidal intent or attempt within previous month
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Veterans Medical Research Foundation

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Albert Y Leung, MD

Role: PRINCIPAL_INVESTIGATOR

San Diego Veterans Healthcare System

Locations

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VA San Diego Healthcare System

San Diego, California, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Caleb Lopez, BS

Role: CONTACT

858-552-8585 ext. 2638

Facility Contacts

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Caleb Lopez, BS

Role: primary

858-552-8585 ext. 2638

Albert Y Leung, MD

Role: backup

Other Identifiers

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W81XWH2110831

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

H210076

Identifier Type: OTHER

Identifier Source: secondary_id

CP200229

Identifier Type: -

Identifier Source: org_study_id

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