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[Pathomechanisms of pain attacks in Horton's headache (cluster headache)]
Insights
Indomethacin did not prevent nitroglycerin-induced Horton's cluster headaches, suggesting arachidonic acid cyclooxygenase products are not involved in cluster headache mechanisms.
Area of Science:
- Neurology
- Pharmacology
Context:
- Horton's cluster headache (HC) is a debilitating neurological disorder with an unclear pathomechanism.
- Nitroglycerin is a known trigger for cluster headache attacks.
Purpose:
- To investigate the role of arachidonic acid cyclooxygenase (AACO) pathway products in the pathomechanism of Horton's cluster headaches.
Summary:
- Nine patients with Horton's cluster headaches underwent a challenge test with nitroglycerin.
- Patients received indomethacin (75-100 mg daily) for three days to inhibit AACO activity.
- A subsequent nitroglycerin challenge on day four failed to elicit a significant inhibitory effect from indomethacin on headache attacks.
Impact:
- The findings suggest that products of the arachidonic acid cyclooxygenase pathway are unlikely to play a significant role in the pathomechanism of Horton's cluster headaches.
- This study provides evidence against a specific pharmacological target for cluster headache treatment.
Abstract:
In view of the still unexplained pathomechanism of Horton's cluster headaches 9 patients were given a challenge test with nitroglycerin while at the same time the attacks were blocked with indomethacin. The attacks were provoked with one dose (1 mg) of nitroglycerin. Then during 3 days the patients took 75-100 mg indomethacin which dose was quite sufficient for inhibition of the activity of arachidonic acid cyclooxygenase. On the fourth day another nitroglycerine provocation was done. No inhibitory effect of indomethacin on the attack was observed. It seems doubtful that products of arachidonic acid cyclooxygenation play any role in the pathomechanism of this headache.