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Glyceryl trinitrate induced headache in migraineurs - relation to attack frequency
I Christiansen1, D Daugaard, L Lykke Thomsen
1Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark.
European Journal of Neurology
|September 6, 2000
Summary
Glyceryl trinitrate, a nitric oxide precursor, causes more severe headaches in migraineurs than healthy individuals. This heightened sensitivity in migraine patients appears genetically determined, not influenced by attack frequency.
Area of Science:
- Neurology
- Pharmacology
Background:
- Glyceryl trinitrate (GTN), a nitric oxide (NO) prodrug, induces headaches.
- Migraineurs exhibit a more severe headache response to GTN compared to healthy subjects.
Purpose of the Study:
- To investigate if heightened NO sensitivity in migraineurs correlates with migraine attack frequency.
- To determine if GTN-induced headaches in migraineurs are influenced by environmental factors versus inherent mechanisms.
Main Methods:
- Intravenous infusion of GTN (0.5 microg/kg/min) administered to three groups: migraine patients with rare attacks (≤4/year), frequent attacks (≥12/year), and healthy controls.
- Assessment of headache severity, duration, and diagnostic criteria fulfillment for migraine without aura.
Main Results:
- Both rare and frequent migraineurs reported significantly more severe and longer-lasting headaches compared to healthy subjects.
- Migraineurs more often met diagnostic criteria for migraine without aura after GTN infusion.
- No significant difference in headache parameters was observed between rare and frequent migraineurs, despite a trend towards more headaches in frequent sufferers.
Conclusions:
- Migraineurs demonstrate supersensitivity to GTN, indicating a fundamental pathophysiological mechanism involving nitric oxide.
- This NO sensitivity in migraine is likely genetically determined, independent of environmental influences or migraine attack frequency.