Migraine Diagnostics with Special Reference to Pharmacological Tests

Dalsgaard‐Nielsen, T

doi:10.1159/000228235

Cited by 41 publications

(34 citation statements)

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“…A rapid increase in nitric oxide has been shown to result in the transient induction of headache, 15 and the use of the nitric oxide donor nitroglycerin has been associated with headache. 16,17 Similarly, the decrease in headache after the first 2 doses of eculizumab may represent a physiologic restoration to steady-state levels of nitric oxide.…”

Section: Discussionmentioning

confidence: 99%

Multicenter phase 3 study of the complement inhibitor eculizumab for the treatment of patients with paroxysmal nocturnal hemoglobinuria

Brodsky¹,

Young

Antonioli

et al. 2008

Blood

554

548

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The terminal complement inhibitor eculizumab was recently shown to be effective and well tolerated in patients with paroxysmal nocturnal hemoglobinuria (PNH). Here, we extended these observations with results from an open-label, nonplacebo-controlled, 52-week, phase 3 clinical safety and efficacy study evaluating eculizumab in a broader PNH patient population. Eculizumab was administered by intravenous infusion at 600 mg every 7 ؎ 2 days for 4 weeks; 900 mg 7 ؎ 2 days later; followed by 900 mg every 14 ؎ 2 days for a total treatment period of 52 weeks. Ninety-seven patients at 33 international sites were enrolled. Patients treated with eculizumab responded with an 87% reduction in hemolysis, as measured by lactate dehydrogenase levels (P < .001). Baseline fatigue scores in the FACIT-Fatigue instrument improved by 12.2 ؎ 1.1 points (P < .001). Eculizumab treatment led to an improvement in anemia. The increase in hemoglobin level occurred despite a reduction in transfusion requirements from a median of 8.0 units of packed red cells per patient before treatment to 0.0 units per patient during the study (P < .001). Overall, transfusions were reduced 52% from a mean of 12.3 to 5.9 units of packed red cells per patient. Forty-nine patients (51%) achieved transfusion independence for the entire 52-week period. Improvements in hemolysis, fatigue, and transfusion requirements with eculizumab were independent of baseline levels of hemolysis and degree of thrombocytopenia. Quality of life measures were also broadly improved with eculizumab treatment. This study demonstrates that the beneficial effects of eculizumab treatment in patients with PNH are applicable to a broader population of PNH patients than previously studied. This trial is registered at

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Section: Discussionmentioning

confidence: 99%

Multicenter phase 3 study of the complement inhibitor eculizumab for the treatment of patients with paroxysmal nocturnal hemoglobinuria

Brodsky¹,

Young

Antonioli

et al. 2008

Blood

554

548

View full text Add to dashboard Cite

show abstract

“…Because of its distinct bilateral throbbing character, the headache caused by NTG is clearly distinguished from muscle contraction (tension) headache and may be useful as a pharmacologically induced vascular headache model in normal, that is, nonvascular headache or nonmigraine, subjects [19]. The induction of a vascular headache with NTG has also been used as a diagnostic test for suspected vascular headache, particularly cluster headache [18,20,21] . It is the vascular phase of migraine that the NTG-induced headache model attempts to simulate.…”

Section: Discussionmentioning

confidence: 99%

Middle Cerebral Artery Velocity Correlates with Nitroglycerin‐induced Headache Onset

Davidai

et al. 1996

Journal of Neuroimaging

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Headache often accompanies treatment with nitroglycerin, but the cerebral hemodynamic effects and the exact mechanism of the headache are incompletely understood. Transcranial Doppler monitoring allows evaluation and monitoring of changes in blood flow velocity in the large intracranial arteries. The objective of this study was to assess middle cerebral artery (MCA) blood flow velocities with transcranial Doppler monitoring in subjects receiving continuous low-dose nitroglycerin intravenously or by patch, and correlate these with clinical headache. Twenty-eight normal adult men received nitroglycerin (0.12 micrograms/kg/min intravenously [n = 14] or 0.6 mg/min by transdermal patch [n = 14]), for up to 120 minutes, with monitoring of clinical headache status (standard 4-point scale), blood pressure, heart rate, end-expiratory PCO2 (CO2), and right MCA velocity. All subjects developed headache (mean time to onset, 34 min), reaching moderate or severe levels in 20. There were no differences in age, weight, mean blood pressure, mean heart rate, or resting end-tidal CO2 between those whose headache reached a moderate to severe level and those whose headache remained mild. MCA velocity decreased from baseline values at all levels of clinical headache (onset, -17%; moderate, -18%; severe, -16%; nitroglycerin stopped, -19%) (p, 0.0001 by t test for each stage of headache). MCA velocity remained decreased at the time of headache resolution (-14%; p < 0.001). Blood pressure, heart rate, and CO2 did not change significantly. There were no differences related to route of nitroglycerin dosing. These data show that continuous low doses of nitroglycerin by patch or intravenously produce headache in normal male subjects. MCA velocities were significantly decreased at headache onset and at all levels of headache severity. Changes in MCA velocity persisted beyond the clinical headache. These results suggest a direct MCA vasodilatory effect of nitroglycerin. This method may also be used to evaluate the intracranial hemodynamic effects of other vasoactive drugs, even in clinical settings.

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“…Administration of nitroglycerin, a nitric oxide donor, provokes spontaneous-like migraine attacks in migraine patients evaluated during an intercritical phase (1). In 1987, Sicuteri et al (2), referring to their clinical practice over the years, reported two clinical types of headache response to nitroglycerin in migraineurs.…”

Section: Introductionmentioning

confidence: 99%

Reliability of the Nitroglycerin Provocative Test in the Diagnosis of Neurovascular Headaches

Sances¹,

Tassorelli²,

Pucci³

et al. 2004

Cephalalgia

126

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Nitroglycerin administration provokes spontaneous-like migraine attacks in migraine and cluster headache (CH) patients. Nitroglycerin-induced migraine-like headache has been used as an experimental model of migraine. In this paper, we evaluate the possibility of using the nitroglycerin provocative test (NPT) as a supportive measure in the diagnosis of primary neurovascular headaches by assessing its reliability on a large population and adopting strict criteria for rating the response as positive or negative. Our population consisted of 197 migraineurs, 42 subjects suffering from cluster headache and 53 healthy controls. In migraine without aura, the test sensitivity was 82.1%, specificity 96.2% and accuracy 85.5%, while in subjects suffering from migraine with aura, the reliability of the NPT was less satisfactory (sensitivity 13.6%, specificity 96.2% and accuracy 72%). In CH patients tested during the active phase of the disease the sensitivity was 80.6%, specificity 100% and accuracy 92.9%. NPT is an easy, low-cost and reliable method for supporting the diagnosis of migraine without aura and cluster headache.

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Migraine Diagnostics with Special Reference to Pharmacological Tests

Cited by 41 publications

References 0 publications

Multicenter phase 3 study of the complement inhibitor eculizumab for the treatment of patients with paroxysmal nocturnal hemoglobinuria

Multicenter phase 3 study of the complement inhibitor eculizumab for the treatment of patients with paroxysmal nocturnal hemoglobinuria

Middle Cerebral Artery Velocity Correlates with Nitroglycerin‐induced Headache Onset

Reliability of the Nitroglycerin Provocative Test in the Diagnosis of Neurovascular Headaches

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