CHROnic Migraine Embolization

Inclusion criteria

• The patient has read, understood, signed, and dated the Patient Information Sheet with the informed consent form.
• The patient is aged between 21 and 70 years inclusive at the time of signing the Patient Information Sheet with the informed consent form.
• The diagnosis of "chronic migraine" according to the clinical guidelines on migraine by the Ministry of Health of the Russian Federation (2021) / ICD-10 (2018), established at least 12 months before screening.
• Resistant nature of the migraine, determined by the doctor using the criteria of the European Headache Federation (EHF, 2020), established at least 6 months before screening.
• At least 14 days of headache during the screening period (28 days), of which 8 days of headache meet the definition of migraine (assessed based on the results of filling out the Headache Diary for 28 days during the screening period).
• Migraine, resistant to both pharmacological and non-pharmacological prevention and treatment methods, in the patient's history.
• Maximum level of headache during migraine days above 5 points (inclusive) on a 10-point numerical rating scale during the screening period.
• No positive effect on migraine symptoms (frequency and intensity of headache attacks) from previous botulinum toxin therapy (administration of OnabotulinumtoxinA, Relatox® (botulinum toxin type A - hemagglutinin complex 155 - 195 IU, administered every 12 weeks according to the PREEMPT protocol).
• Consent to use adequate contraceptive methods\* and not serve as an egg/sperm donor from the time of signing the Patient Information Sheet with the informed consent form for participation in the study until the end of the study (for women with reproductive potential and men).

Exclusion criteria

• The patient has contraindications to undergoing embolization of the middle meningeal artery based on the medical history, results of examinations, and laboratory tests conducted during screening.
• Allergic reactions to contrast agents used during procedures before/during the embolization procedure and associated procedures.
• The patient has a history of cerebral vascular malformations, arteriovenous malformations, brain aneurysms, brain tumors, hydrocephalus, arachnoiditis, cerebrospinal fluid circulation disorders, craniovertebral junction anomalies, platybasia, skull base deformities, severe traumatic brain injuries, stenosis, and occlusion of pre-cerebral arteries.
• The patient has a history of skull base fractures and consequences of skull base fractures, history of neurosurgical operations.
• A history of mental illness (including depression, confirmed by a psychiatrist during screening through the HADS questionnaire and Hamilton scale assessment), which, in the opinion of the psychiatrist, may affect the patient's ability to assess their condition, interfere with participation in the study, or impact the patient's safety during the study.
• A history of hyperthyroidism or diabetes. The presence of other endocrine disorders in the patient's history that, in the doctor's opinion, could interfere with participation in the study or affect the evaluation of efficacy and/or safety.
• History or data of drug addiction, alcoholism, or abuse of medications.
• Medication-induced headache at the time of screening and within 3 months (12 weeks) prior to screening.
• Other types of chronic headache in the patient's history within less than 12 months before screening, such as trigeminal autonomic cephalalgias (including cluster headaches, prolonged hemicrania), new daily persistent headaches, painful cranial neuropathies, retinal migraine, aura without headache, hemiplegic migraine, brainstem aura migraine, idiopathic intracranial hypertension without optic nerve edema, spontaneous intracranial hypertension, secondary headaches.
• The patient is unable to distinguish a migraine headache from other types of headache.
• The patient has migraine complications, such as status migrainosus, persistent aura without infarction, migraine infarction, migraine aura (as a trigger for epileptic seizures).
• Body mass index (BMI) below 18.5 or above 39.9 kg/m².
• The onset of migraine was diagnosed at an age older than 50 years.
• The presence of metabolic syndrome or cachexia.
• Severe cardiovascular diseases currently or in the past, including: chronic heart failure class III or IV (according to the New York Heart Association classification), clinically significant ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation), significant heart valve diseases, uncontrolled hypertension with systolic blood pressure \> 180 mm Hg and diastolic blood pressure \> 110 mm Hg, pulmonary embolism, or deep vein thrombosis.
• Varicose veins of the lower limbs, history of lower limb vein thrombosis.
• Ischemic heart disease, atherosclerosis of coronary vessels.
• Stenotic atherosclerosis of brachiocephalic arteries in the patient's history.
• Acute cerebrovascular accident or its consequences in the patient's history.
• The patient is pregnant or plans to become pregnant within the next 3 months.
• Atrial fibrillation, patent foramen ovale, anomalies of the interatrial septum, history of heart and coronary vessel surgeries.
• Signs of blood clotting disorders in the patient's history and screening, history of antiphospholipid syndrome.
• Use of anticoagulant drugs less than 5 days before the procedure.
• Uncontrolled bronchial asthma, severe chronic obstructive pulmonary disease in the patient's history.
• Renal insufficiency at screening based on the calculation of glomerular filtration rate (GFR) ≤ 60 mL/min, based on serum creatinine levels at screening, or a history of renal insufficiency.
• History of liver insufficiency, elevated ALT and AST levels at screening.
• History of generalized pain syndrome, fibromyalgia.
• For women: use of combined oral contraceptives with a history of thrombosis of any localization.
• History of epilepsy, epileptic syndrome, seizure disorders, neurological conditions other than the primary condition (migraine).
• Presence of antibodies to HIV, hepatitis C virus, hepatitis B surface antigen (HbsAg), antibodies to T. Pallidum, or a history of HIV infection, hepatitis B, hepatitis C, or syphilis, either in the medical history or based on the results of serological blood tests at screening.
• Malignant neoplasms within 5 years before screening, or current or suspected oncological disease.
• Other serious, unstable, decompensated, or clinically significant medical or psychological conditions that, in the opinion of the doctor, may interfere with the patient's participation in the study or affect the evaluation of efficacy and/or safety.
• Participation in other interventional clinical trials, including the study completion visit, within 30 days prior to the screening, or planning to participate in such studies during the current study. Participation in non-interventional registry or epidemiological studies is allowed.
• The patient is unable to read or write, unwilling or unable to comply with the study protocol procedures; any other conditions that, in the opinion of the doctor, may prevent participation in the study, adherence to procedures, or contradict the patient's interests, as well as affect the study results.
• Employees of the medical institution conducting the study or the sponsor company, their family members, or subjects in dependent relationships.