Heparin in Migraine Headache

Two recent reports on reduction of migraine attacks during treatment with vitamin K antagonists have caught my attention. 1,2 Being a migraine sufferer myself, with considerable improvement of my headache during the use of warfarin, I became interested in the subject. Recently, a young man sought my advice for migraine attacks which had worsened after the withdrawal of warfarin. The previous reports on migraine and warfarin involved elderly patients. 1,2 I report now on these two patients in their 30s, one of them being myself (case 1), who have experienced reduction of migraine attacks during the use of warfarin.Key words: migraine, warfarin (Headache 1997;37:667-668) CASE HISTORIES Case 1.-A 39-year-old woman had suffered migraine attacks since childhood. The migraine was both with and without aura, and visual auras not followed by headache were frequent. The headache was moderate/intense with the usual autonomic symptoms which accompany these attacks. The frequency of attacks was one to two per week and visual auras with no headaches were even more frequent. Prophylactic treatment with flunarizine had not improved the headache or the visual disturbances.In May 1994, due to mitral valve stenosis, atrial fibrillation, and pulmonary embolism, heparin was administered for 3 days, after which warfarin 5 mg/ day was started. The International Normalization Ratio (INR) was kept at 2.5. Digoxin 0.25 mg/day was also prescribed. These medications were continued for 15 months, during which the frequency and intensity of the headache attacks decreased to less than one attack per month, of moderate intensity. The frequency of visual auras without headache was reduced as well, though episodes of aura were still present at least once a week. During mitral valve commissurotomy in December 1994, warfarin was discontinued and the headache returned with nearly daily frequency, though this was attributed to the surgical stress. Warfarin was restarted a week after the surgery and continued for another 8 months, during which period the headache was again very rare. Due to the reduction of the size of the left atrium and return to sinus rhythm, warfarin was discontinued in August 1996. Ten days later, the headache returned with the same characteristics, frequency, and intensity which were observed before warfarin. Propranolol 20 mg/day was added to digoxin due to episodes of sinus tachycardia, but the headache profile has not altered.Case 2.-A 34-year-old man underwent stomach surgery in March 1996. Two weeks later, the patient developed deep venous thrombosis and was treated with subcutaneous heparin for 1 month, after which warfarin 5 mg/day was started. The INR was kept at 2.5. Bromazepam 3 mg/day was also prescribed. The patient, who presented occasional attacks (once a month or less) of migraine without aura for many years, became headache-free for the 5-month period of treatment with warfarin. Two weeks after discontinuation of this medication, the patient began to have frequent attacks of migraine and dizziness. His compl...

Section: Commentsmentioning

confidence: 99%

Reduction of Migraine Attacks During the Use of Warfarin

Fragoso¹

1997

“…EVIDENCE WAS presented that basophilic leukocytes participate in the migraine syndrome through the release of heparin-carrying granules. 1,2,3,4 The response of basophilic leukocytes of migraine patients to challenge with certain vasoactive mediators and with heparin, and the alterations in composition of plasma lipids, suggested a possible deficiency of endogenous heparin. This view was supported by the normalizing effect of repeated injections of heparin on basophilic leukocytes and plasma lipids of migraine patients and by the improvement in the course of migraine.…”

Section: (Headache 16:284-292 1977)mentioning

confidence: 99%

Migraine Therapy With Heparin: Pathophysiologic Basis

Thonnard-Neumann¹

1977

Self Cite

SYNOPSIS During headache‐free intervals, migraine patients had in their blood fewer basophilic leukocytes, which also contained less than a normal amount of heparin, and excreted less uroheparin than did controls. During migraine attacks the levels of basophils and of uroheparin rose but did not reach normal values. Sixty patients with severe vascular headaches (fifty‐three migraine and seven cluster) were treated with heparin by intravenous injections or aerosol inhalations. After repeated treatments, basophilic leukocytes and uroheparin levels rose to normal values and remained normal for varying periods, up to 14 months, after the end of therapy. Of the two treatment forms, aerosol therapy was the more effective. It reduced the migraine index of all but two of thirty‐three patients by an average of 86 (75–100) percent, whereas after intravenous therapy eighteen of twenty‐seven patients showed a better than 75 percent improvement. Three to 14 months after the end of therapy, seven patients were entirely free from migraine headaches and three more reported an average improvement of 90 percent. The role of endogenous heparin in migraine and the fate of injected and inhaled heparin are reviewed.

“…Several case reports and one observational study suggest vitamin K antagonists (VKAs) may improve migraine symptoms . Other anticoagulants have been reported less in the literature, with only one study exploring benefits of heparin in migraine . It is currently unknown whether direct acting oral Factor Xa inhibitors have a similar effect on migraine symptoms.…”

Section: Introductionmentioning

confidence: 99%

A Case of Migraine With Aura Resolving on Warfarin But Not on Apixaban

Nilsson

Bungard

2017

Several case reports have associated anticoagulants such as heparin and vitamin K antagonists with reduced symptoms in migraine, but no data exist for direct acting oral factor Xa inhibitors. We report the case of a 55-year-old female who experienced complete remission of migraine with aura for 12 years while on warfarin, with return of symptoms within 3 weeks of switching to apixaban, and resolution of symptoms once again within days of warfarin resumption. Our case suggests that anticoagulation alone is not sufficient to improve migraine symptoms. Further study of vitamin K-dependent proteins not involved in anticoagulation, such as the relatively novel growth arrest-specific gene 6, may clarify the link between warfarin and migraine symptoms.