Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Denmark.
Cephalalgia. 2022 Jun;42(7):598-607. doi: 10.1177/03331024211060002. Epub 2021 Dec 7.
In the general population 4% have never experienced a headache. Freedom from headache could be due to distinctive protective mechanisms or a lack of environmental risk factors for headache. Isosorbide-5-mononitrate is an organic nitrate which in the body is metabolised to nitric oxide. The nitric oxide pathway plays a crucial role in the primary headaches. We hypothesized that people who are free from headache are protected by distinctive mechanisms in the nitric oxide pathway.
We performed an observer blinded case-control study using nitric oxide to provoke a headache. 32 headache free male participants and 26 randomly selected male controls received 60 mg Isosorbide-5-mononitrate orally on the study day. Participants fill out a headache diary with headache intensity and characteristics until 12 hours after administration of Isosorbide-5-mononitrate. Primary endpoint were areas under the curve of headache intensity score.
All 58 participants completed the study. There was no significant difference in headache incidence, headache intensity score or migraine-like attack between headache free participants and controls.
We show that men who have never experienced a headache develop a headache when provoked with Isosorbide-5-mononitrate. This indicates that freedom from headache in men is not related to the nitric oxide pathway which is involved in the primary headache disorders.
在普通人群中，有 4%的人从未经历过头痛。没有头痛可能是由于独特的保护机制或缺乏头痛的环境风险因素。异山梨醇-5-单硝酸酯是一种有机硝酸盐，在体内代谢为一氧化氮。一氧化氮途径在原发性头痛中起着至关重要的作用。我们假设没有头痛的人在一氧化氮途径中具有独特的保护机制。
我们进行了一项观察者盲法病例对照研究，使用一氧化氮诱发头痛。32 名无头痛的男性参与者和 26 名随机选择的男性对照者在研究日口服 60mg 异山梨醇-5-单硝酸酯。参与者在服用异山梨醇-5-单硝酸酯后 12 小时内填写头痛日记，记录头痛强度和特征。主要终点是头痛强度评分的曲线下面积。
所有 58 名参与者均完成了研究。无头痛参与者和对照组在头痛发生率、头痛强度评分或偏头痛样发作方面无显著差异。
我们表明，从未经历过头痛的男性在用异山梨醇-5-单硝酸酯诱发头痛时会出现头痛。这表明男性没有头痛与原发性头痛障碍中涉及的一氧化氮途径无关。
