Juhász Gabriella, Zsombók Terézia, Gonda Xénia, Bagdy György
Országos Pszichiátriai és Neurológiai Intézet, Neurokémiai és Neuropszichofarmakológiai Laboratórium, Budapest.
Orv Hetil. 2004 Nov 14;145(46):2323-8.
Headache is the most prominent side effect of nitrate therapy. Lack of compliance is usually associated with headache which has a detrimental effect on quality of life. In spite of the high frequency of this adverse effect, the headache characteristics, timing and risk factors are less known. On the other hand, intravenously administered nitroglycerin-induced migraine attack is a common human research model in migraine. AIM OF THE PRESENT STUDY: to evaluate the headaches occurring after administration of therapeutic dose of sublingual nitroglycerin, in migraineurs and controls.
Twenty-eight female migraine patients without aura and 14 healthy controls received 0.5 mg nitroglycerin. Headache intensity and characteristics have been investigated for 24 hours.
two types of headache developed after the nitroglycerin administration: (1) an immediate headache that does not fulfil the criteria for migraine, mild and disappears spontaneously within 1 hour; (2) a typical migraine attack without aura develops several hours after the nitroglycerin administration (mean latency: 250 min), moderate or severe, and warrants antimigraine therapy. The two types of headache developed independently. The nitroglycerin-induced headaches have not been determined solely by the previous migraine diagnosis, although both immediate (p = 0.0045) and typical migraine headache (p = 0.00047) were significantly more frequent among migraineurs compared to controls. Moreover, those control subjects who experienced migraine attacks had predispositions to migraine. Previous results of the authors supported that lower platelet serotonin concentration and higher plasma CGRP concentration, during the headache free period, are risk factors that express greater susceptibility to develop both spontaneous and nitroglycerin-induced migraine attack.
Authors suggest an accurate exploration of the headache case-history before nitroglycerin treatment. This makes it possible to give proper information to migraine patients and possible migraine patients, and thus suitable treatment can be offered if needed.
头痛是硝酸盐治疗最突出的副作用。依从性差通常与头痛有关，而头痛会对生活质量产生不利影响。尽管这种不良反应很常见，但其头痛特征、发作时间和危险因素却鲜为人知。另一方面，静脉注射硝酸甘油诱发的偏头痛发作是偏头痛研究中常用的人体研究模型。本研究的目的：评估偏头痛患者和对照组在舌下含服治疗剂量硝酸甘油后出现的头痛情况。
28名无先兆的女性偏头痛患者和14名健康对照者接受了0.5毫克硝酸甘油治疗。对头痛强度和特征进行了24小时的调查。
硝酸甘油给药后出现了两种类型的头痛：（1）一种即刻头痛，不符合偏头痛标准，程度较轻，1小时内自行消失；（2）典型的无先兆偏头痛发作在硝酸甘油给药数小时后出现（平均潜伏期：250分钟），程度为中度或重度，需要进行抗偏头痛治疗。这两种类型的头痛是独立发生的。硝酸甘油诱发的头痛并非仅由先前的偏头痛诊断决定，尽管与对照组相比，偏头痛患者中即刻头痛（p = 0.0045）和典型偏头痛头痛（p = 0.00047）的发生率明显更高。此外，那些经历过偏头痛发作的对照受试者有偏头痛的易感性。作者之前的研究结果支持，在无头痛期血小板血清素浓度较低和血浆降钙素基因相关肽浓度较高是易发生自发性和硝酸甘油诱发偏头痛发作的危险因素。
作者建议在硝酸甘油治疗前准确了解头痛病史。这使得能够向偏头痛患者和可能患有偏头痛的患者提供适当信息，从而在需要时提供合适的治疗。
