Prednisolone reduces nitric oxide-induced migraine
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Prednisolone reduces nitric oxide-induced migraine. / Tfelt-Hansen, P; Daugaard, D; Lassen, L H; Iversen, Helle Klingenberg; Olesen, J.
In: European journal of neurology : the official journal of the European Federation of Neurological Societies, Vol. 16, No. 10, 10.2009, p. 1106-11.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Prednisolone reduces nitric oxide-induced migraine
AU - Tfelt-Hansen, P
AU - Daugaard, D
AU - Lassen, L H
AU - Iversen, Helle Klingenberg
AU - Olesen, J
PY - 2009/10
Y1 - 2009/10
N2 - BACKGROUND AND PURPOSE: Glyceryl trinitrate (GTN) induces delayed migraine attacks in migraine patients. The purpose of this study was to investigate whether pre-treatment with prednisolon could decrease this effect of GTN.METHODS: In this double-blind, randomized and placebo-controlled, crossover study 15 migraineurs with migraine without aura were pre-treated with 150 mg of prednisolone or placebo followed by a 20-min infusion of GTN (0.5 ug/kg/min). One hour after the GTN-infusion, the participants were sent home, but continued to rate headache and possible associated symptoms by filling out a headache diary every hour for 12 h. There were two equal primary efficacy end-points: frequency of delayed migraine and intensity of delayed headache.RESULTS: Nine patients experienced a GTN headache fulfilling the diagnostic criteria for migraine without aura on the placebo day compared with four patients on the prednisolone day (P = 0.14). Prednisolone pre-treatment did not alter the summed or peak immediate headache responses to GTN significantly (P = 0.08, P = 0.07), whereas the peak headache scores during the following 12 h were significantly lower after prednisolone pre-treatment (median peak score = 1, range 0-8) compared with placebo (median = 4, range 0-8) (P < 0.01). There was no difference between the two treatment days in the effect of GTN on blood flow velocity of the middle cerebral artery (a decrease) or on the dilation of the superficial temporal artery or the radial artery.CONCLUSION: Pre-treatment with prednisolone did not reduce the immediate GTN-induced headache, did not inhibit the frequency of delayed headache but significantly decreased the intensity of delayed GTN-induced headache. These findings suggest that GTN causes induction of inflammatory mediators, and that this is the mechanism of delayed GTN-induced migraine. They also support a role of inflammatory mediators in spontaneous migraine attacks.
AB - BACKGROUND AND PURPOSE: Glyceryl trinitrate (GTN) induces delayed migraine attacks in migraine patients. The purpose of this study was to investigate whether pre-treatment with prednisolon could decrease this effect of GTN.METHODS: In this double-blind, randomized and placebo-controlled, crossover study 15 migraineurs with migraine without aura were pre-treated with 150 mg of prednisolone or placebo followed by a 20-min infusion of GTN (0.5 ug/kg/min). One hour after the GTN-infusion, the participants were sent home, but continued to rate headache and possible associated symptoms by filling out a headache diary every hour for 12 h. There were two equal primary efficacy end-points: frequency of delayed migraine and intensity of delayed headache.RESULTS: Nine patients experienced a GTN headache fulfilling the diagnostic criteria for migraine without aura on the placebo day compared with four patients on the prednisolone day (P = 0.14). Prednisolone pre-treatment did not alter the summed or peak immediate headache responses to GTN significantly (P = 0.08, P = 0.07), whereas the peak headache scores during the following 12 h were significantly lower after prednisolone pre-treatment (median peak score = 1, range 0-8) compared with placebo (median = 4, range 0-8) (P < 0.01). There was no difference between the two treatment days in the effect of GTN on blood flow velocity of the middle cerebral artery (a decrease) or on the dilation of the superficial temporal artery or the radial artery.CONCLUSION: Pre-treatment with prednisolone did not reduce the immediate GTN-induced headache, did not inhibit the frequency of delayed headache but significantly decreased the intensity of delayed GTN-induced headache. These findings suggest that GTN causes induction of inflammatory mediators, and that this is the mechanism of delayed GTN-induced migraine. They also support a role of inflammatory mediators in spontaneous migraine attacks.
KW - Adult
KW - Analysis of Variance
KW - Blood Flow Velocity
KW - Cerebrovascular Circulation
KW - Cross-Over Studies
KW - Double-Blind Method
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Migraine without Aura
KW - Nitroglycerin
KW - Pain Measurement
KW - Prednisolone
KW - Severity of Illness Index
U2 - 10.1111/j.1468-1331.2009.02654.x
DO - 10.1111/j.1468-1331.2009.02654.x
M3 - Journal article
C2 - 19614965
VL - 16
SP - 1106
EP - 1111
JO - European Journal of Neurology
JF - European Journal of Neurology
SN - 1351-5101
IS - 10
ER -
ID: 128983050