Migraine With and Without Aura: The Same Disease Due to Cerebral Vasospasm of Different Intensity. A hypothesis based on CBF studies during migraine.

Olsen, Tom Skyhøj

doi:10.1111/j.1526-4610.1990.hed3005269.x

Cited by 41 publications

(19 citation statements)

References 15 publications

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“…To this end, MO and MA are different in multiple aspects, but it remains to be seen if they form parts of a spectrum of headache disorders [23]. Reduced excitability of the visual and motor cortices in migraine patients is recognized.…”

Section: Discussionmentioning

confidence: 99%

Clinical correlates of phosphene perception in migraine without aura: An Asian study

Lum

Fook‐Chong

et al. 2008

Journal of the Neurological Sciences

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Section: Discussionmentioning

confidence: 99%

Clinical correlates of phosphene perception in migraine without aura: An Asian study

Lum

Fook‐Chong

et al. 2008

Journal of the Neurological Sciences

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“…This effect is explained by two possible mechanisms. The first one sees migraine deriving from cerebral oligemia [22, 23], and acetazolamide acting through vasodilatation. The second attributes migraine to a possible disorder of neuronal ion channels [21].…”

Section: Discussionmentioning

confidence: 99%

Acetazolamide for the prophylaxis of migraine in CADASIL: a preliminary experience

et al. 2012

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Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited microangiopathy caused by NOTCH3 mutations. It is characterized by migraine, with or without aura, ischemic events, psychiatric and cognitive disturbances. There is no approved treatment for migraine prophylaxis in CADASIL, but acetazolamide has been anecdotally reported to be effective. We retrospectively reviewed our database of patients with a genetic diagnosis of CADASIL to identify how many of them were treated with acetazolamide for the prophylaxis of migraine. The efficacy and the tolerability of this treatment were checked looking at the clinic reports. Acetazolamide was prescribed in seven patients; the mean duration of treatment was 6 months, and the daily dose ranged from 125 to 500 mg. Three patients had a total and sustained remission, while in two patients a reduction in attacks and an improvement of the headache intensity were recorded. In one of these, acetazolamide was deliberately taken only during the migraine attack and the beneficial effect started 1 h after administration. In two patients, the drug did not produce any beneficial effect. Mild side effects were recorded in two patients. Our preliminary experience expands previous reports and confirms the possible efficacy of acetazolamide in CADASIL migraine. Based on these data, a randomized controlled trial seems worthy to be carried out to test the efficacy and safety of this drug.

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“…Although the mechanism is not clear, there are several possible ways by which it may influence or inhibit the migraine attack. Third, a spreading wave of oligaemia appears to occur in migraine with aura (5). Shifts in the circadian rhythm have been shown to exist during a migraine attack (2).…”

Section: To the Editormentioning

confidence: 99%

“…First, high GABA levels in the hypothalamus suggest an important role for GABA in the neural control of endogenous circadian rhythms. The increased brain GABA level in ischaemia is thought to be evidence of a protective inhibitory activity of GABA in the brain (5,8). The circadian rhythm can be repositioned by the administration of sodium valproate (3), Second, prolactin may be involved in the mechanism of migraine attacks.…”

Section: To the Editormentioning

confidence: 99%

Acute Myocardial Infarction in a Young Female Migraineur: Sumatriptan Suspected, But Found Not Guilty

1994

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Recent reports (1-4) of adverse cardiac events following the administration of sumatriptan have raised concern among doctors and patients. The following case report underlines the difficulties in establishing a causal association between drugs and acute medical events. A 44-year-old Dutch woman suddenly developed chest pain and collapsed while on holiday in Belgium. She was found in ventricular fibrillation when the ambulance staff arrived and received several DC shocks. She had an inferior postero-lateral myocardial infarction, was treated with tissue plasminogen activator and admitted to the University Hospital; she never regained consciousness and died 10 h after the initial event. On autopsy, an acute infarction of most of the postero-lateral cardiac wall and a 70% single atheromatous stenosis of the initial second segment of the right coronary artery were found. Since it appeared from a rudimentary history taken on admission that this patient was a known migraineur on sumatriptan, her record was tentatively classified as acute myocardial infarction secondary to sumatriptan-induced vasospasm of a stenotic coronary artery.In accordance with the available data this diagnosis appeared plausible. Sumatriptan has possibly promoted coronary vasospasm in at least two women in the absence of any other underlying cardiovascular disease and of any concomitant drug use (3-first patient, 4). It has been shown during diagnostic coronary arteriography that 6 mg subcutaneous sumatriptan can reduce the mean coronary artery diameter by an average of 17% (5). However, when this patient's husband and general practitioner were questioned in more detail about her medical history and recent drug utilization, it appeared most unlikely that sumatriptan was responsible for the cardiac event. Although she had been taking sumatriptanregularly for 18 months, with total satisfaction and without any cumbersome adverse event, she had not used this drug, nor any other antimigraine medication since her arrival in Belgium one week prior to her death. With the exception of contraceptive pills (gestoden-ethinylestradiol), no drug was found in her personal belongings and sumatriptan was not on the Belgian market at the time. Since plasma half-life of sumatriptan (2 h) and its pharmacodynamic effects on both cerebral (6) and coronary (5) arteries are short-lived (less than 1 h), we felt at last that sumatriptan was not guilty and that this patient's acute myocardial infarction had been brought on by the association of heavy smoking and hormonal contraception.

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Migraine With and Without Aura: The Same Disease Due to Cerebral Vasospasm of Different Intensity. A hypothesis based on CBF studies during migraine.

Cited by 41 publications

References 15 publications

Clinical correlates of phosphene perception in migraine without aura: An Asian study

Clinical correlates of phosphene perception in migraine without aura: An Asian study

Acetazolamide for the prophylaxis of migraine in CADASIL: a preliminary experience

Acute Myocardial Infarction in a Young Female Migraineur: Sumatriptan Suspected, But Found Not Guilty

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