Myocardial infarction after chronic ergotamine abuse

Roithinger, F X; Punzengruber, Christian; Gremmel, Franz; Hinterreiter, M; Holzner, F; Pachinger, Otmar

doi:10.1093/eurheartj/14.11.1579

Cited by 6 publications

(5 citation statements)

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“…5Valvular heart disease can also be accompanied by myocardial ischemia, pain, claudication and ischemia in upper or lower limbs or a combination of the previous ones, and sometimes symptoms related to heart failure are the ones that lead the patient to consult. (6,7) This pathophysiological event is mediated by the stimulation of alpha adrenergic receptors in the smooth muscle, leading to an important vasospasm and loss of endothelial integrity; (8) some authors have tried to screen this population, Rasmussen VG, et al evaluated 138 patients who received treatment with ergotamine-derived agonists and described 25% of patients with some degree of valvular involvement, found severe aortic insufficiency (n = 4), moderate aortic insufficiency (n = 12), mitral (n = 3) and tricuspid valve insufficiency (n = 5). Two patients had a coexisting mitral insufficiency and moderate tricuspid valve insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Disease Associated with the Chronic Use of Ergotamine: A Case Report

2018

IJCR

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Ergotamine and its derivatives were used for multiple diseases; in the nineties, its use in association with caffeine was considered a standard treatment for migraines, although it has been in decline, due to the evidenced toxic effects related to its chronic use including vascular, cardiovascular and central nervous system manifestations. In this article is reported a case of a 59-yearold female with chronic use of caffeine plus ergotamine for more than 20 years; afterwards she develops peripheral artery disease, severe mitral and tricuspid valve regurgitation with requirement of valve replacement. In the absence of past cardiovascular history and rheumatic fever, its clinical evolution and pathology results are associated with ergotism.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular Disease Associated with the Chronic Use of Ergotamine: A Case Report

2018

IJCR

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“…[15][16][17] In order to overcome this problem of "confounding by contraindication," we included ASA users as the control group. Despite these limitations, we feel that the observed reduction in therapeutic intensity of abortive migraine drug use during coumarin therapy is a true phenomenon and unbiased.…”

Section: Commentsmentioning

confidence: 99%

“…In view of the vasoconstrictive properties of ergotamine and sumatriptan, physicians may have generally been more reluctant to prescribe these drugs to migraineurs recently having experienced cardiovascular or thromboembolic complications, which are the indications for coumarin or ASA treatment 15‐17 . In order to overcome this problem of “confounding by contraindication,” we included ASA users as the control group.…”

Section: Commentsmentioning

confidence: 99%

Reduction in the Intensity of Abortive Migraine Drug Use During Coumarin Therapy

et al. 2001

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Objective.-To investigate the impact of coumarin therapy on migraine attack frequency. Background.-Sporadic case reports and clinical studies have described beneficial effects of coumarin therapy on migraine severity.Design and Methods.-A retrospective follow-up study based on a prescription database covering a population of 450000 was conducted. All patients using an abortive migraine drug (ergotamine or sumatriptan) and subsequently treated with either coumarin (index group) or low-dose acetylsalicylic acid (control group) were analyzed. The impact of coumarin and low-dose acetylsalicylic acid on the frequency of migraine attacks was assessed by measuring the intensity of ergotamine and sumatriptan use, in defined daily doses per month per patient, before and during coumarin or acetylsalicylic acid treatment. In addition, a "therapeutic intensity reduction" was determined for each patient.Results.-The study population consisted of 92 patients; 35% had been prescribed coumarin and 65% had been prescribed low-dose acetylsalicylic acid after the initiation of ergotamine or sumatriptan. Two thirds of the study population was treated with ergotamine. Overall, ergotamine and sumatriptan use for the coumarin cohort decreased from 6.4 defined daily doses per month prior to coumarin treatment to 3.0 defined daily doses during coumarin treatment, compared with a reduction from 5.2 defined daily doses per month to 4.4 defined daily doses per month for the lowdose acetylsalicylic acid cohort ( P Ͼ .05). The therapeutic intensity of ergotamine and sumatriptan use was significantly decreased by 40% for the coumarin cohort, compared with 4.7% for the low-dose acetylsalicylic acid cohort (P ϭ .004).Conclusions.-We observed that coumarin treatment was clearly associated with a reduction in the therapeutic intensity of abortive migraine drug use in comparison with low-dose aspirin treatment. This suggests that, overall, the coumarin cohort had experienced a substantial reduction in the frequency of migraine attacks during anticoagulation treatment. Our findings, as well as those of others, justify a controlled clinical trial to further establish the effects of coumarin therapy on migraine severity and its possible role in the prophylactic management of patients suffering from migraine. Key words: anticoagulation, impact, migraine, ergotamine, sumatriptan, consumption Abbreviations: DDDs defined daily doses, OAC oral anticoagulation with coumarin derivatives, ASA acetylsalicylic acid ( Headache 2001;41:768-773) A few case reports have described a complete resolution of migraine or a substantial reduction in frequency and intensity of migraine attacks in migraineurs with or without aura during treatment with oral anticoagulant drugs, such as warfarin or acenocoumarol. [1][2][3][4] In addition, a recent patient questionnaire study in 400 subjects treated with acenocoumarol for nonneurological indications revealed that oral anticoagulation produced improvement of headache in 63% of patients with migraine versus 38% of patients w...

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“…Another side e¤ect of ET is vasoconstriction of the small vessels with limb ischemia and gangrene (Lipton 1997), known as the phenomenon of ergotism since the Middle Ages (Friedman 1979), and with coronary artery disease (Roithinger et al 1993;Silberstein and Young 1995). Ergotamine abuse also a¤ects the distensibility of large arteries (Barenbrock et al 1996).…”

Section: Introductionmentioning

confidence: 99%

The impact of ergotamine-induced headache and ergotamine withdrawal on information processing

et al. 1999

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Ergotamine abuse and subsequent ergotamine-induced headache is a common problem in the pharmacological treatment of migraine and other headache types; often, withdrawal therapy is necessary. This study investigated whether ergotamine abuse affects information processing and whether withdrawal therapy can lead to an improvement of information processing. We designed a standardized neurophysiological retrospective (ergotamine abuse) and prospective (ergotamine withdrawal) study in a supraregional headache outpatient clinic. Seventy-one patients abusing ergotamine derivatives with subsequent daily headache were enrolled and compared to 36 migraine patients without ergotamine intake and 36 healthy subjects. Information processing was evaluated by latencies and amplitudes of visually evoked event-related potentials (ERP) before and after ergotamine withdrawal therapy. P3 latency of the ERP was significantly increased in ergotamine abuse (442 +/- 45 ms) versus migraine (415 +/- 40 ms) and healthy subjects (410 +/- 33 ms), there was no difference between ergotamine tartrate and dihydroergotamine abuse. The migraine specific loss of habituation in information processing as measured by P3 latency could not be observed in migraine patients with ergotamine abuse. After successful withdrawal therapy in 36 patients, the abnormally prolonged P3 latency was significantly shortened (452 +/- 47 ms versus 433 +/- 30 ms; P < 0.004). Our findings imply that information processing is impaired by ergotamine abuse and can be improved but not normalized after withdrawal therapy. Furthermore, our data provide strong evidence that ergotamine, besides its peripheral effects, has a central mode of action.

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Myocardial infarction after chronic ergotamine abuse

Cited by 6 publications

References 0 publications

Cardiovascular Disease Associated with the Chronic Use of Ergotamine: A Case Report

Cardiovascular Disease Associated with the Chronic Use of Ergotamine: A Case Report

Reduction in the Intensity of Abortive Migraine Drug Use During Coumarin Therapy

The impact of ergotamine-induced headache and ergotamine withdrawal on information processing

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