Psilocybin for the Treatment of Migraine Headache

• ClinicalTrials.gov Identifier: NCT03341689
• Recruitment Status: Active, not recruiting
• First Posted: November 14, 2017
• Last Update Posted: January 26, 2023
• Sponsor: Yale University
• Information provided by (Responsible Party): Deepak C. D'Souza, Yale University

Study Description

Brief Summary:

The purpose of this study is to investigate the effects of oral psilocybin in migraine headache. Subjects will each receive a dose of placebo and a dose of psilocybin approximately 14 days apart. Subjects will be randomized to the order of treatment and they will be randomized to receive either low or high dose psilocybin. Subjects will maintain a headache diary prior to, during, and after the treatments in order to document headache frequency and intensity, as well as associated symptoms. This preliminary study will inform on the basic effects of psilocybin in migraine headache and inform on the design of larger, more definitive studies.

Condition or disease	Intervention/treatment	Phase
Migraine Headache	Drug: High Dose Psilocybin; Drug: Low Dose Psilocybin; Drug: Placebo	Phase 1

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 24 participants
• Allocation: Randomized
• Intervention Model: Crossover Assignment
• Masking: Double (Participant, Care Provider)
• Primary Purpose: Treatment
• Official Title: Safety and Efficacy of Psilocybin for the Treatment of Headache Disorders: Sub-Study I
• Actual Study Start Date: November 1, 2017
• Estimated Primary Completion Date: December 2023
• Estimated Study Completion Date: December 2023

Arms and Interventions

Arm	Intervention/treatment
Experimental: Placebo/Low Dose Psilocybin; Subjects in this arm receive placebo in the first session and low dose psilocybin in the second session.	Drug: Low Dose Psilocybin; 0.0143 mg/kg psilocybin capsule; Drug: Placebo; microcrystalline cellulose capsule
Experimental: Placebo/High Dose Psilocybin; Subjects in this arm receive placebo in the first session and high dose psilocybin in the second session.	Drug: High Dose Psilocybin; 0.143 mg/kg psilocybin capsule; Drug: Placebo; microcrystalline cellulose capsule
Experimental: Low Dose Psilocybin/Placebo; Subjects in this arm receive low dose psilocybin in the first session and placebo in the second session.	Drug: Low Dose Psilocybin; 0.0143 mg/kg psilocybin capsule; Drug: Placebo; microcrystalline cellulose capsule
Experimental: High Dose Psilocybin/Placebo; Subjects in this arm receive high dose psilocybin in the first session and placebo in the second session.	Drug: High Dose Psilocybin; 0.143 mg/kg psilocybin capsule; Drug: Placebo; microcrystalline cellulose capsule

Outcome Measures

Primary Outcome Measures :

1. Change in migraine headache days [ Time Frame: From two weeks before first session to two weeks after second session using a headache diary ]
   Average days (number of days per week)
2. Change in migraine attack frequency [ Time Frame: From two weeks before first session to two weeks after second session using a headache diary ]
   Average number (number per week)
3. Change in migraine attack duration [ Time Frame: From two weeks before first session to two weeks after second session using a headache diary ]
   Average duration (measured in hours)
4. Change in pain intensity of migraine attacks [ Time Frame: From two weeks before first session to two weeks after second session using a headache diary ]
   Average pain intensity (4-tiered pain score; 0=none, 1=mild, 2=moderate, 3=severe)
5. Change in intensity of nausea/vomiting during migraine attacks [ Time Frame: From two weeks before first session to two weeks after second session using a headache diary ]
   Average intensity (4-tiered pain score; 0=none, 1=mild, 2=moderate, 3=severe)
6. Change in intensity of photophobia [ Time Frame: From two weeks before first session to two weeks after second session using a headache diary ]
   Average intensity (4-tiered pain score; 0=none, 1=mild, 2=moderate, 3=severe)
7. Change in intensity of phonophobia [ Time Frame: From two weeks before first session to two weeks after second session using a headache diary ]
   Average intensity (4-tiered pain score; 0=none, 1=mild, 2=moderate, 3=severe)
8. Change in migraine attack-related functional disability [ Time Frame: From two weeks before first session to two weeks after second session using a headache diary ]
   Average disability (4-tiered pain score; 0=none, 1=mild, 2=moderate, 3=severe)

Secondary Outcome Measures :

1. Change in the use of abortive/rescue medication [ Time Frame: From two weeks before first session to two weeks after second session using a headache diary ]
   number of days (number of days per week using a migraine abortive)
2. Time to first migraine attack [ Time Frame: From the day of each session until two weeks after each test session ]
   Measured in days
3. Time to second migraine attack [ Time Frame: From the day of each session until two weeks after each test session ]
   Measured in days
4. Quality of life using the Centers for Disease Control (CDC) Health-Related Quality of Life Scale: Healthy Days Symptoms Module [ Time Frame: From two weeks before first session to three months after second session using a headache diary ]

   4 questions scored 0 to 30 each; higher numbers indicate worse quality of life.

   (1) pain-related impairment, (2) mood symptoms, (3) anxiety symptoms, and (4) lack of sleep Percent change for each measure as well as total score (range 0 to 120) will be calculated.

5. Psychedelic effects using the 5-Dimensional Altered States of Consciousness (5D-ASC) scale [ Time Frame: Taken on each test day approximately 6 hours after drug administration ]
   94 questions scored 0 to 100 each; higher numbers indicate greater psychedelic effects Questions address 5 dimensions: (1) Oceanic boundlessness (score range 0-2700), (2) Dread of Ego Dissolution (score range 0-2100), (3) Visionary Restructuralization (score range 0-1800), (4) Auditory Alterations (score range 0-1600), and (5) Vigilance reduction (score range 0-1200) Score for each dimension as well as total score (range 0 to 9400) will be measured.
6. Change in blood pressure [ Time Frame: Measured during each test session prior to drug administration, every 15 minutes in the first hour, every 30 minutes in the second hour, and then hourly for 4 hours or until resolution of psychedelic effects (~6 hours post drug) ]
   Maximum change in mean arterial blood pressure from baseline during each test day (mmHg)
7. Change in heart rate [ Time Frame: Measured during each test session prior to drug administration, every 15 min in the first hour, every 30 min in the second hour, and then hourly for 4 hours or until resolution of psychedelic effects (~6 hours post drug) ]
   Maximum change from baseline during each test day (beats per minute)
8. Change in peripheral oxygenation [ Time Frame: Measured during each test session prior to drug administration, every 15 min in the first hour, every 30 min in the second hour, and then hourly for 4 hours or until resolution of psychedelic effects (~6 hours post drug) ]
   Maximum change from baseline during each test day (SpO2)

Eligibility Criteria

• Ages Eligible for Study: 21 Years to 65 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Diagnosis of migraine headache per ICHD-3beta criteria
• Typical pattern of migraine attacks with approximately two migraines or more weekly
• Attacks are managed by means involving no more than twice weekly triptan use
• Age 21 to 65

Exclusion Criteria:

• Axis I psychotic disorder (e.g. schizophrenia, bipolar I, depression with psychosis)
• Axis I psychotic disorder in first degree relative
• Unstable medical condition, severe renal, cardiac or hepatic disease, pacemaker, or serious central nervous system pathology
• Pregnant, breastfeeding, lack of adequate birth control
• History of intolerance to psilocybin, LSD, or related compounds
• Drug or alcohol abuse within the past 3 months (excluding tobacco)
• Urine toxicology positive to drugs of abuse
• Use of vasoconstrictive medications (i.e. sumatriptan, pseudoephedrine, midodrine) within 5 half-lives of test days
• Use of serotonergic antiemetics (i.e. ondansetron) in the past 2 weeks
• Use of antidepressant medication (i.e. TCA, MAOI, SSRI) in the past 6 weeks
• Use of steroids or certain other immunomodulatory agents (i.e. azathioprine) in the past 2 weeks

Contacts and Locations

Locations

United States, Connecticut

VA Connecticut Healthcare System, West Haven Campus

West Haven, Connecticut, United States, 06516

Sponsors and Collaborators

Yale University

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Schindler EAD, Sewell RA, Gottschalk CH, Luddy C, Flynn LT, Lindsey H, Pittman BP, Cozzi NV, D'Souza DC. Exploratory Controlled Study of the Migraine-Suppressing Effects of Psilocybin. Neurotherapeutics. 2021 Jan;18(1):534-543. doi: 10.1007/s13311-020-00962-y. Epub 2020 Nov 12.

• Responsible Party: Deepak C. D'Souza, Professor, Yale University
• ClinicalTrials.gov Identifier: NCT03341689
• Other Study ID Numbers: 1607018057.A
• First Posted: November 14, 2017
• Last Update Posted: January 26, 2023
• Last Verified: January 2023

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Deepak C. D'Souza, Yale University:

Psilocybin

Additional relevant MeSH terms:

Migraine Disorders; Headache; Headache Disorders, Primary; Headache Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Pain; Neurologic Manifestations; Psilocybin; Hallucinogens; Physiological Effects of Drugs; Psychotropic Drugs