Hypersensitivity to BKCa channel opening in persistent post-traumatic headache

Haidar M Al-Khazali, Rune H Christensen, David W Dodick, Basit Ali Chaudhry, Anna G Melchior, Rami Burstein, Håkan Ashina

Abstract

BACKGROUND: Large conductance calcium-activated potassium (BKCa) channels have been implicated in the neurobiological underpinnings of migraine. Considering the clinical similarities between migraine and persistent post-traumatic headache (PPTH), we aimed to examine whether MaxiPost (a BKCa channel opener) could induce migraine-like headache in persons with PPTH.

METHODS: This is a randomized double-blind, placebo-controlled, two-way crossover study from September 2023 to December 2023. Eligible participants were adults with PPTH after mild traumatic brain injury who reported having no personal history of migraine. The randomized participants received a single dose of either MaxiPost (0.05 mg/min) or placebo (isotonic saline) that was infused intravenously over 20 minutes. The two experiment sessions were scheduled at least one week apart to avoid potential carryover effects. The primary endpoint was the induction of migraine-like headache after MaxiPost as compared to placebo within 12 hours of drug administration. The secondary endpoint was the area under the curve (AUC) values for headache intensity scores between MaxiPost and placebo over the same 12-hour observation period.

RESULTS: Twenty-one adult participants (comprising 14 females and 7 males) with PPTH were enrolled and completed both experiment sessions. The proportion of participants who developed migraine-like headache was 11 (52%) of 21 participants after MaxiPost infusion, in contrast to four (19%) participants following placebo (P = .02). Furthermore, the median headache intensity scores, represented by AUC values, were higher following MaxiPost than after placebo (P < .001).

CONCLUSIONS: Our results indicate that BKCa channel opening can elicit migraine-like headache in persons with PPTH. Thus, pharmacologic blockade of BKCa channels might present a novel avenue for drug discovery. Additional investigations are nonetheless needed to confirm these insights and explore the therapeutic prospects of BKCa channel blockers in managing PPTH.

GOV IDENTIFIER: NCT05378074.

Original languageEnglish
Article number102
JournalThe Journal of Headache and Pain Online
Volume25
Issue number1
Pages (from-to)102
ISSN1129-2377
DOIs
Publication statusPublished - 18 Jun 2024

Keywords

  • Humans
  • Female
  • Male
  • Adult
  • Double-Blind Method
  • Cross-Over Studies
  • Post-Traumatic Headache/drug therapy
  • Migraine Disorders/drug therapy
  • Middle Aged
  • Brain Concussion/complications
  • Large-Conductance Calcium-Activated Potassium Channel alpha Subunits/antagonists & inhibitors
  • Young Adult
  • Large-Conductance Calcium-Activated Potassium Channels
  • Pathogenesis
  • BK channels
  • Drug targets
  • Head pain
  • Head trauma

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