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Medication-overuse headache overlapping with serotonin syndrome.

Sanjay Prakash1, Harsh Patel2, Chetsi Sudhir Shah2

  • 1Neurolgy, SBKS Medical Institute and Research Centre, Sumandeep Vidyapeeth, Vadodara, Gujarat, India drprakashs@yahoo.co.in.

BMJ Case Reports
|January 4, 2024
PubMed
Summary
This summary is machine-generated.

Serotonin syndrome (SS) can occur in chronic migraine patients using certain medications. Early treatment with cyproheptadine effectively resolved SS symptoms and improved migraine control.

Keywords:
Drug interactionsHeadache (including migraines)

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Area of Science:

  • Neurology
  • Pharmacology

Background:

  • Serotonin syndrome (SS) is a drug-induced condition resulting from elevated intrasynaptic serotonin.
  • Serotonin is implicated in migraine pathophysiology, with 5-HT2A receptor upregulation observed in medication-overuse headache (MOH).
  • Many migraine treatments target serotonin receptors.

Observation:

  • Two patients with chronic migraine developed MOH, presenting with headache and withdrawal-like symptoms.
  • Physical examination revealed signs consistent with SS, including hyperreflexia, clonus, tachycardia, and hypertension.
  • Both patients met the diagnostic criteria for Serotonin Syndrome.

Findings:

  • Administration of cyproheptadine led to rapid improvement in SS symptoms within 24 hours.
  • Complete resolution of symptoms, including headaches, was observed within 7 days.
  • Continued cyproheptadine use as a preventative measure effectively controlled migraine frequency.

Implications:

  • This case series highlights the potential for SS in patients with chronic migraine and MOH.
  • Cyproheptadine appears to be an effective treatment for SS in this context.
  • The findings suggest a role for cyproheptadine in managing both SS and migraine frequency.