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Post-Traumatic HeadacheAMMONCT06669780

e-CBT DTx for Post Traumatic Headaches in Adults With History of TBI

A study testing AMMO PTH DTx in people with Post-Traumatic Headache, run by Henry M. Jackson Foundation for the Advancement of Military Medicine at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The AMMO digital therapeutic (DTx) study will provide an online based program for participants with migraines after head injury to follow for 12 weeks. This study aims to see if using cognitive behavioral therapy aimed at military service members in an online self administered platform is effective therapy in the… Read more about this study

Who is it for?
Ages 18 to 70 years
Conditions the study is for
Post-Traumatic Headache
What is being tested?
AMMO PTH DTx
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
83 participants
Where
1 siteUnited States
Study dates
3 Jan 2024to 27 Apr 2026
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 70 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Be aged ≥ 18 to ≤ 70 years
  • Have a history of concussive TBI ≥ 3 months prior to enrollment:
  • A concussive TBI is defined by having at least one of the following after a head trauma (ACRM, 1993) oAny period of loss of consciousness; oAny loss of memory for events immediately before or after the accident; oAny alteration in mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused); and oFocal neurological deficit(s) that may or may not be transient oThe injury must not exceed any of the following (ACRM, 1993):
  • Loss of consciousness of approximately 30 minutes or less;
  • After 30 minutes an initial GCS score of 13-15; and
  • PTA not greater than 24 hours
Show all 41Show fewer
  • Head trauma resulting in concussive TBI can be due to blast or non-blast mechanisms
  • Head trauma resulting in concussive TBI can have occurred any time in the participant's life: prior to military service, during deployment, in garrison, or after leaving military service
  • Have a history of chronic PTH defined as:
  • o Headache is reported to have developed (or worsened) after one of the following:
  • The injury to the head;
  • Regaining of consciousness following the injury to the head; or
  • Discontinuation of medication(s) impairing ability to sense or report headache following the injury to the head
  • Not better accounted for by another ICHD-3 diagnosis**
  • o The headache persists for >3 months after its onset (ICHD, 2013)
  • Have a HIT-6™ score of ≥ 56 to 78 indicative of substantial impact (56-59) or severe impact (60-78) on functioning (Yang, Rendas-Baum, Varon, \& Kosinski, 2011)
  • Be able to provide written, informed consent in English and follow study-related instructions
  • Have ownership of or reliable access to a smartphone with a data plan or internet connecting capabilities
  • Be aged ≥ 18 to ≤ 70 years
  • Have a history of concussive TBI ≥ 3 months prior to enrollment:
  • A concussive TBI is defined by having at least one of the following after a head trauma (ACRM, 1993):
  • Any period of loss of consciousness;
  • Any loss of memory for events immediately before or after the accident;
  • Any alteration in mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused); and
  • Focal neurological deficit(s) that may or may not be transient
  • The injury must not exceed any of the following (ACRM, 1993):
  • Loss of consciousness of approximately 30 minutes or less;
  • After 30 minutes an initial GCS score of 13-15; and
  • PTA not greater than 24 hours
  • Head trauma resulting in concussive TBI can be due to blast or non-blast mechanisms
  • Head trauma resulting in concussive TBI can have occurred any time in the participant's life: prior to military service, during deployment, in garrison, or after leaving military service
  • Have a history of chronic PTH defined as:
  • o Headache is reported to have developed (or worsened) after one of the following:
  • The injury to the head;
  • Regaining of consciousness following the injury to the head; or
  • Discontinuation of medication(s) impairing ability to sense or report headache following the injury to the head
  • Not better accounted for by another ICHD-3 diagnosis**
  • o The headache persists for >3 months after its onset (ICHD, 2013)
  • Have a HIT-6™ score of ≥ 56 to 78 indicative of substantial impact (56-59) or severe impact (60-78) on functioning (Yang, Rendas-Baum, Varon, \& Kosinski, 2011)
  • Be able to provide written, informed consent in English and follow study-related instructions
  • Have ownership of or reliable access to a smartphone with a data plan or internet connecting capabilities

Who cannot join

  • They experienced a moderate or severe TBI
  • Their secondary headache is better accounted for by the ICHD-3 diagnosis of 8.2 medication-overuse headache; must meet diagnostic criteria for at least 1 medication-overuse headache diagnosis (8.2.1-8.2.8)
  • They are currently engaged in psychotherapeutic treatment or have engaged in psychotherapeutic treatment within 8 weeks prior to trial enrollment (for more information regarding recent treatment in potential participants, see section '3.2 Study Procedures,' sub-section 'Baseline Evaluation')
  • They report change or discontinuation of headache prophylaxis in the past 4 weeks
  • They report active psychotic or bipolar symptoms
  • In the opinion of the investigator, they have other considerations that may adversely affect patient safety, participation, or scientific validity of the data being collected (including, but not limited to, active plan or intent for suicide, visual impairment, hand dysfunction or amputation, substantial cognitive impairment, life expectancy of less than 6 months)

Trial locations and contacts

1 site in 1 country.

United States1 site
  • 100% Remote Recruitment: Center for Neurscience and Regenerative Medicine

    Bethesda, Maryland, 20817

Other trials in United States

About this study

Official title: Single-Blind, Randomized, Controlled Pilot Trial of a Cognitive-Behavioral Therapy Digital Therapeutic Delivered Online for Post-Traumatic Headaches in Adults With History of Concussive Traumatic Brain Injury

The AMMO digital therapeutic (DTx) study will provide an online based program for participants with migraines after head injury to follow for 12 weeks. This study aims to see if using cognitive behavioral therapy aimed at military service members in an online self administered platform is effective therapy in the relief of migraines compared. The study will use a single blind online comparative program to test the effect.

Read the detailed description

The AMMO digital therapeutic (DTx) will be a novel intervention for PTH following concussive TBI, therefore this project is a pilot trial designed to test this new treatment. This pilot is a single-blind, randomized, controlled, interventional trial of current and former military personnel along with civilians with a history of concussive TBI and current PTH. The pilot trial will be conducted via online portal accessible by smartphone, tablet, or computer with remote interaction between participants and study staff. The pilot trial will include up to 100 participants randomized to either the active intervention or a comparison condition at a 1:1 ratio, and will provide preliminary data to determine the sample size of a future full clinical trial. Participants will complete a 12 week intervention period followed by a follow-up assessment 4 weeks after intervention is complete. Participants randomized to the comparison group will be provided access to the open label after end of 16 week follow-up.

In addition, updates to the DTx to improve usability and acceptability will be made if necessary based on feedback from the pilot trial, then applied to the final DTx used in a future, larger, clinical trial.

Being tested
AMMO PTH DTx, AMMO SHAM
Medical subject headings
Post-Traumatic Headache

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • AMMO PTH DTxDevice

    An online cognitive behavioral therapy program accessed through a online program.

  • AMMO SHAMDevice

    Online activities not including CBT in the AMMO online program.

Study groups in NCT06669780
Study groupRoleWhat they receive
ActiveExperimentalThis arm will receive access to an online program that will guide them through cognitive behavioral therapy program.
Receives: Device: AMMO PTH DTx
Sham comparatorSham comparatorParticipants will obtain access to an online program with activities not including the cognitive behavioral therapy
Receives: Device: AMMO SHAM

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. 6-Item Headache Impact Test™ (HIT-6™)

    The HIT-6™ is a brief standardized headache screening tool and questionnaire, derived from the original 54-item Headache Impact Test. It has been found to have good psychometric properties in assessing headache impact among patients in clinical practice and research (Bjorner, Kosinski, \& Ware, 2003; Kosinski et al., 2003).

    Measured: 16 weeks

Secondary outcomes (8)
  1. Determine the appropriate sample size for a future full clinical trial based on preliminary estimates of effect size for outcome measures

    Use of Headache Impact Test and number of headache days per month to compare arms. This data will identify any changes to sample size in future studies.

    Measured: 12 weeks

  2. Post Traumatic Stress Disorder Checklist (DSM-5)

    The PCL-5 is a self-report questionnaire designed to assess symptoms of PTSD (Blevins, Weathers, Davis, Witte, \& Domino, 2015). The PCL-5 takes approximately 5-10 minutes to complete.

    Measured: 16 weeks

  3. Traumatic Brain Injury Quality of Life Scale (TBI-QOL)

    The TBI-QOL is a self-report questionnaire composed of 22 item banks (Tulsky et al., 2016). It was developed to measure multiple domains of life for patients living with TBI, including physical, mental, cognitive, and social. The TBI-QOL takes approximately 30 minutes to complete.

    Measured: 16 weeks

  4. Patient Health Questionnaire-9

    The PHQ-9 is a self-report assessment for depressive symptoms (Kroenke, Spitzer, \& Williams, 2001). Each item is scored on a scale of 0 to 3 providing a summary score that ranges from 0 to 27, with higher scores representing more severe depression. On the PHQ-9 a total score <5 is considered minimal depression, and scores of 5 to 9, 10 to 14, 15 to 19, and 20 to 27 are considered mild, moderate, moderately severe, and severe depression, respectively.

    Measured: 16 weeks

  5. Insomnia Severity Index (ISI)

    The ISI is a self-report questionnaire designed to assess the presence and severity of primary insomnia sleep disorder and is empirically-validated in general and military populations (Bastien et al., 2001; Jenkins et al., 2015; Morin, Belleville, Belanger, \& Ivers, 2011).

    Measured: 16 weeks

  6. User Version of the Mobile Application Rating Scale

    Adapted from the Mobile Application Rating Scale (MARS), the uMARS is a 26-item self-report questionnaire designed to assess the quality, functionality, and aesthetics of a mobile application and its information (Stoyanov, Hides, Kavanagh, \& Wilson, 2016). There is an additional open-text question for further comments on the users' opinions of the application. The uMARS takes approximately 15 minutes to complete. This measure will be optional for participants to complete.

    Measured: 12 weeks

  7. Mobile Agnew Relationship Measure

    The mARM is an adaptation of a valid and reliable assessment of therapeutic alliance in face-to-face therapy (Berry, Salter, Morris, James, \& Bucci, 2018). The 25-item questionnaire has been adjusted for use with digital health interventions, specifically for mental health. The mARM takes approximately 5 minutes to complete.

    Measured: 12 weeks

  8. User Program Feedback Questionnaire

    Brief questionnaire utilizing Likert Scales related to gathering user feedback on personal experience with ease and accessibility of app utilization.

    Measured: 12 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Nov 2024
  2. Study start3 Jan 2024
  3. Primary completion16 Jan 2026
  4. Study completion27 Apr 2026

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
83 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06669780
Sponsor's protocol ID
AMMO-TBI-2023
Acronym
AMMO
Status last verified
May 2026
First submitted
24 Jun 2024
Last updated
15 May 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes

Publications

  • Berry K, Salter A, Morris R, James S, Bucci S. Assessing Therapeutic Alliance in the Context of mHealth Interventions for Mental Health Problems: Development of the Mobile Agnew Relationship Measure (mARM) Questionnaire. J Med Internet Res. 2018 Apr 19;20(4):e90. doi: 10.2196/jmir.8252.

    PubMed 29674307
  • Stoyanov SR, Hides L, Kavanagh DJ, Wilson H. Development and Validation of the User Version of the Mobile Application Rating Scale (uMARS). JMIR Mhealth Uhealth. 2016 Jun 10;4(2):e72. doi: 10.2196/mhealth.5849.

    PubMed 27287964
  • Morin CM, Belleville G, Belanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011 May 1;34(5):601-8. doi: 10.1093/sleep/34.5.601.

    PubMed 21532953
  • Jenkins MM, Colvonen PJ, Norman SB, Afari N, Allard CB, Drummond SP. Prevalence and Mental Health Correlates of Insomnia in First-Encounter Veterans with and without Military Sexual Trauma. Sleep. 2015 Oct 1;38(10):1547-54. doi: 10.5665/sleep.5044.

    PubMed 26085301
  • Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001 Jul;2(4):297-307. doi: 10.1016/s1389-9457(00)00065-4.

    PubMed 11438246
  • Tulsky DS, Kisala PA, Victorson D, Carlozzi N, Bushnik T, Sherer M, Choi SW, Heinemann AW, Chiaravalloti N, Sander AM, Englander J, Hanks R, Kolakowsky-Hayner S, Roth E, Gershon R, Rosenthal M, Cella D. TBI-QOL: Development and Calibration of Item Banks to Measure Patient Reported Outcomes Following Traumatic Brain Injury. J Head Trauma Rehabil. 2016 Jan-Feb;31(1):40-51. doi: 10.1097/HTR.0000000000000131.

    PubMed 25931184
  • Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13. doi: 10.1046/j.1525-1497.2001.016009606.x.

    PubMed 11556941
  • Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation. J Trauma Stress. 2015 Dec;28(6):489-98. doi: 10.1002/jts.22059. Epub 2015 Nov 25.

    PubMed 26606250
  • Kosinski M, Bjorner JB, Ware JE Jr, Batenhorst A, Cady RK. The responsiveness of headache impact scales scored using 'classical' and 'modern' psychometric methods: a re-analysis of three clinical trials. Qual Life Res. 2003 Dec;12(8):903-12. doi: 10.1023/a:1026111029376.

    PubMed 14651411
  • Bjorner JB, Kosinski M, Ware JE Jr. Using item response theory to calibrate the Headache Impact Test (HIT) to the metric of traditional headache scales. Qual Life Res. 2003 Dec;12(8):981-1002. doi: 10.1023/a:1026123400242.

    PubMed 14651417

Questions about this trial

What is this clinical trial studying?

A study testing AMMO PTH DTx in people with Post-Traumatic Headache, run by Henry M. Jackson Foundation for the Advancement of Military Medicine at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 41 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 15 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

6-Item Headache Impact Test™ (HIT-6™) (time frame: 16 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06669780, which also lists 10 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 May 2026.

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