Dipyridamole May Induce Migraine in Patients With Migraine Without Aura

Abstract

Dipyridamole inhibits phosphodiesterase 5 (PDE5) and adenosine re-uptake. The most prominent side-effect is headache. We examined the migraine-generating effects of dipyridamole as well as the cerebral blood velocity response in a single-blind study, including 10 patients with migraine without aura and 10 healthy subjects. Dipyridamole 0.142 mg/kg per min was administered intravenously. Headache intensity was scored on a verbal rating scale along with pain characteristics and accompanying symptoms. Blood velocity in the middle cerebral artery (V(mca)), blood pressure and heart rate were recorded repeatedly. Headache was induced in all migraine patients and in eight of 10 healthy subjects (P = 0.47) with no significant difference in headache intensity (P = 0.53). However, five patients but only one healthy subject experienced the symptoms of migraine without aura, according to ICHD-2 criteria, within 12 h (P = 0.14). Four patients reported photophobia after dipyridamole compared with no healthy subjects (P = 0.087). V(mca) decreased (P < 0.001) during and after dipyridamole infusion with no difference between groups (P = 0.15) coinciding with initiation, but not cessation of immediate headache. Thus, dipyridamole induces symptoms of migraine and an initial decrease in V(mca) in migraine patients, but not significantly more than in healthy subjects. This relatively low frequency of migraine induction, compared with nitric oxide donors and sildenafil, is probably due to the less specific action of dipyridamole on the cGMP signalling pathway as well as a possible bidirectional effect of adenosine on migraine induction.

Factors Influencing Non-cardiac Side Effects of Dipyridamole When Used for Myocardial Perfusion Stress Testing

“…Half of patients experienced more than one side effect; this observation is in agreement with Perper and Segall [11]. Kruuse et al [22] suggested that a higher incidence of headaches could be partially the result of caffeine withdrawal, as patients are asked to refrain from any form of caffeine consumption for 24 hours before the test.…”

“…Only Meyers et al [22] and White [21] listed the frequency of side effects in approximately the same order as this study, but not the same percentage of the population. This general disagreement may be explained by three points.…”

Titrated Initiation of Acetylsalicylic Acid-Dipyridamole Therapy Reduces Adverse Effects and Improves Tolerance in Patients With Stroke

“…Ó 2008 by National Stroke Association Despite the major benefit of aspirin (acetylsalicylic acid [ASA])-dipyridamole therapy over ASA alone for reduction of recurrent stroke 1 and combined vascular disease 2 in patients at high risk for stroke/transient ischemic attack (TIA), a significant number of patients taking standard twice-daily dose discontinue therapy because of side effects including gastrointestinal (GI) symptoms and headache; the mechanism of the latter has been linked to dipyridamole inhibition of phosphodiesterase 5 and adenosine reuptake. 3 Migraineurs appear to be particularly susceptible to dipyridamole-induced headache. 3 Attempts to overcome dipyridamole-mediated headache through pre-emptive analgesic (acetaminophen) use has been unsuccessful, 4 whereas initial dose reduction was met with variable results.…”

“…3 Migraineurs appear to be particularly susceptible to dipyridamole-induced headache. 3 Attempts to overcome dipyridamole-mediated headache through pre-emptive analgesic (acetaminophen) use has been unsuccessful, 4 whereas initial dose reduction was met with variable results. 5,6 In this study we assessed the tolerance of titrated initiation of ASA-dipyridamole (25/200 mg) once daily for 1 week followed by standard twice daily dose in patients with stroke/TIA.…”

Dipyridamole-Associated Headache in Stroke Patients – Interindividual Differences?

“…The mechanistic action for this DP-associated headache is unknown, although there are possible similar mechanisms to the vascular headache in nitrate treatment or migraine [6, 7]. However, not only stroke patients suffer from headache with DP but also healthy individuals, in whom headache is more common during the first days of treatment followed by a decline [6].…”