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Sokolov AY, Volynsky MA, Potapenko AV, Iurkova PM, Zaytsev VV, Nippolainen E, Kamshilin AA. Duality in response of intracranial vessels to nitroglycerin revealed in rats by imaging photoplethysmography. Sci Rep 2023; 13:11928. [PMID: 37488233 PMCID: PMC10366118 DOI: 10.1038/s41598-023-39171-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/20/2023] [Indexed: 07/26/2023] Open
Abstract
Among numerous approaches to the study of migraine, the nitroglycerin (NTG) model occupies a prominent place, but there is relatively insufficient information about how NTG affects intracranial vessels. In this study we aim to assess the effects of NTG on blood-flow parameters in meningeal vessels measured by imaging photoplethysmography (iPPG) in animal experiments. An amplitude of the pulsatile component (APC) of iPPG waveform was assessed before and within 2.5 h after the NTG administration in saline (n = 13) or sumatriptan (n = 12) pretreatment anesthetized rats in conditions of a closed cranial window. In animals of both groups, NTG caused a steady decrease in blood pressure. In 7 rats of the saline group, NTG resulted in progressive increase in APC, whereas decrease in APC was observed in other 6 rats. In all animals in the sumatriptan group, NTG administration was accompanied exclusively by an increase in APC. Diametrically opposite changes in APC due to NTG indicate a dual effect of this drug on meningeal vasomotor activity. Sumatriptan acts as a synergist of the NTG vasodilating action. The results we obtained contribute to understanding the interaction of vasoactive drugs in the study of the headache pathophysiology and methods of its therapy.
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Affiliation(s)
- Alexey Y Sokolov
- Department of Neuropharmacology, Valdman Institute of Pharmacology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
- Laboratory of Cortico-Visceral Physiology, Pavlov Institute of Physiology of the Russian Academy of Sciences, Saint Petersburg, Russia
| | - Maxim A Volynsky
- School of Physics and Engineering, ITMO University, Saint Petersburg, Russia
- Laboratory of Functional Materials and Systems for Photonics, Institute of Automation and Control Processes of Far East Branch of the Russian Academy of Sciences, Vladivostok, Russia
| | - Anastasiia V Potapenko
- Department of Neuropharmacology, Valdman Institute of Pharmacology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
- Laboratory of Biochemistry, Medical Genetic Center, Saint Petersburg, Russia
| | - Polina M Iurkova
- Laboratory of Functional Materials and Systems for Photonics, Institute of Automation and Control Processes of Far East Branch of the Russian Academy of Sciences, Vladivostok, Russia
- Faculty of General Therapy, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Valeriy V Zaytsev
- Laboratory of Functional Materials and Systems for Photonics, Institute of Automation and Control Processes of Far East Branch of the Russian Academy of Sciences, Vladivostok, Russia
| | - Ervin Nippolainen
- Laboratory of Functional Materials and Systems for Photonics, Institute of Automation and Control Processes of Far East Branch of the Russian Academy of Sciences, Vladivostok, Russia
| | - Alexei A Kamshilin
- Laboratory of Functional Materials and Systems for Photonics, Institute of Automation and Control Processes of Far East Branch of the Russian Academy of Sciences, Vladivostok, Russia.
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Moir ME, Vermeulen TD, Smith SO, Woehrle E, Matushewski BJ, Zamir M, Shoemaker JK. Vasodilatation by carbon dioxide and sodium nitroglycerin reduces compliance of the cerebral arteries in humans. Exp Physiol 2021; 106:1679-1688. [PMID: 34117663 DOI: 10.1113/ep089533] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/09/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Vascular compliance importantly contributes to the regulation of cerebral perfusion and complex mechanisms are known to influence compliance of a vascular bed: while vasodilatation mediates changes in vascular resistance, does it also affect compliance, particularly in the cerebral vasculature? What is the main finding and its importance? Cerebral vasodilatation, elicited by hypercapnia and sodium nitroglycerin administration, reduced cerebrovascular compliance by approximately 26% from baseline. This study provides new insight into mechanisms mediating cerebrovascular compliance. ABSTRACT Changes in vascular resistance and vascular compliance contribute to the regulation of cerebral perfusion. While changes in vascular resistance are known to be mediated by vasodilatation, the mechanisms contributing to changes in vascular compliance are complex. In particular, whether vasodilatation affects compliance of the vasculature within the cranium remains unknown. Therefore, the present study examined the impact of two vasodilatation pathways on cerebrovascular compliance in humans. Fifteen young, healthy adults (26 ± 5 years, seven females) completed two protocols: (i) sublingual sodium nitroglycerin (SNG; 0.4 mg) and (ii) hypercapnia (5-6% carbon dioxide gas mixture for 4 min). Blood pressure waveforms (finger photoplethysmography) and middle cerebral artery blood velocity waveforms (transcranial Doppler ultrasound) were input into a modified Windkessel model and an index of cerebrovascular compliance (Ci) was calculated. During the SNG protocol, Ci decreased 24 ± 17% from baseline ((5.0 ± 2.3) × 10-4 cm s-1 mmHg-1 ) to minute 10 ((3.6 ± 1.2) × 10-4 cm s-1 mmHg-1 ; P = 0.009). During the hypercapnia protocol, Ci decreased 28 ± 9% from baseline ((4.4 ± 1.9) × 10-4 cm s-1 mmHg-1 ) to minute 4 ((3.1 ± 1.4) × 10-4 cm s-1 mmHg-1 ; P < 0.001). Cerebral vasodilatory stimuli induced by nitric oxide and carbon dioxide mechanisms reduced compliance of the cerebral vascular bed by approximately 26% from supine baseline values.
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Affiliation(s)
- M Erin Moir
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - Tyler D Vermeulen
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - Sydney O Smith
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - Emilie Woehrle
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - Brad J Matushewski
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - Mair Zamir
- Department of Applied Mathematics, University of Western Ontario, London, Ontario, Canada.,Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - J Kevin Shoemaker
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada.,Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
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3
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Michels L, Villanueva J, O'Gorman R, Muthuraman M, Koirala N, Büchler R, Gantenbein AR, Sandor PS, Luechinger R, Kollias S, Riederer F. Interictal Hyperperfusion in the Higher Visual Cortex in Patients With Episodic Migraine. Headache 2019; 59:1808-1820. [PMID: 31680242 DOI: 10.1111/head.13646] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Migraine pathophysiology is complex and probably involves cortical and subcortical alterations. Structural and functional brain imaging studies indicate alterations in the higher order visual cortex in patients with migraine. Arterial spin labeling magnetic resonance imaging (ASL-MRI) is a non-invasive imaging method for assessing changes in cerebral blood flow (CBF) in vivo. OBJECTIVE To examine if interictal CBF differs between patients with episodic migraine (EM) with or without aura and healthy controls (HC). METHODS We assessed interictal CBF using 2D pseudo-continuous ASL-MRI on a 3 Tesla Philips scanner (University Hospital Zurich, Switzerland) in EM (N = 17, mean age 32.7 ± 9.9, 13 females) and HC (N = 19, mean age 31.0 ± 9.3, 11 females). RESULTS Compared to HC, EM showed exclusively hyperperfusion in the right MT+ and Cohen's d effect size was 0.99 (HC mean CBF ± SD: 33.1 ± 5.9 mL/100 g/minutes; EM mean CBF: 40.9 ± 9.4 mL/100 g/minutes). EM with aura (N = 13, MwA) revealed hyperperfusion compared to HC in the right MT+ and superior temporal gyrus. For MT, Cohen's d effect size was 1.34 (HC mean CBF ± SD: 33.1 ± 5.9 mL/100 g/minutes; MwA mean CBF: 43.3 ± 8.6 mL/100 g/minutes). For the superior temporal gyrus, Cohen's d effect size was 1.28 (HC mean CBF ± SD: 40.1 ± 4.9 mL/100 g/minutes; MwA mean CBF: 47.4 ± 6.4 mL/100 g/minutes). In EM, anxiety was positively associated with CBF in the parietal operculum and angular gyrus. CONCLUSIONS Our results suggest that extrastriate brain regions probably involved in cortical spreading depression are associated with CBF changes in the interictal state. We conclude that ASL-MRI is a sensitive method to identify local neuro-functional abnormalities in CBF in patients with EM in the interictal state.
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Affiliation(s)
- Lars Michels
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland.,Center for MR-Research, University Children's Hospital Zurich, Zurich, Switzerland
| | - Jeanette Villanueva
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Ruth O'Gorman
- Center for MR-Research, University Children's Hospital Zurich, Zurich, Switzerland
| | - Muthuraman Muthuraman
- Biomedical Statistics and Multimodal Signal Processing Unit, Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Johannes-Gutenberg-University Hospital, Mainz, Germany
| | - Nabin Koirala
- Biomedical Statistics and Multimodal Signal Processing Unit, Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Johannes-Gutenberg-University Hospital, Mainz, Germany
| | - Roman Büchler
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas R Gantenbein
- University of Zurich, Zurich, Switzerland.,RehaClinic Bad Zurzach, Bad Zurzach, Switzerland
| | - Peter S Sandor
- University of Zurich, Zurich, Switzerland.,RehaClinic Bad Zurzach, Bad Zurzach, Switzerland
| | - Roger Luechinger
- Institute for Biomedical Engineering, ETH Zurich and University of Zurich, Zurich, Switzerland
| | - Spyros Kollias
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Franz Riederer
- University of Zurich, Zurich, Switzerland.,Neurological Center Rosenhuegel and Karl Landsteiner Institute for Epilepsy Research and Cognitive Neurology, Vienna, Austria
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Demartini C, Greco R, Zanaboni AM, Sances G, De Icco R, Borsook D, Tassorelli C. Nitroglycerin as a comparative experimental model of migraine pain: From animal to human and back. Prog Neurobiol 2019; 177:15-32. [DOI: 10.1016/j.pneurobio.2019.02.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 01/19/2019] [Accepted: 02/10/2019] [Indexed: 12/13/2022]
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Gazerani P, Cairns BE, Yassin H, Yousefi JT, Sherzaman AR, Nedergaard BS, Boldsen SK. Amplification of glyceryl trinitrate-induced headache features by noxious craniofacial stimuli in pain-free healthy humans. Pain Manag 2019; 9:17-35. [PMID: 30501556 DOI: 10.2217/pmt-2018-0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Glyceryl trinitrate (GTN) provokes an immediate migraine-like headache, followed by a delayed migraine attack in migraineurs. In healthy volunteers, only an immediate, less severe and shorter headache occurs. The presence of an already sensitized nervous system in migraineurs may underlie the more intense and prolonged GTN-evoked headaches. We tested if in healthy humans, application of noxious cutaneous and/or mechanical stimulation within craniofacial region would enhance or prolong GTN-evoked headache. MATERIALS & METHODS Noxious stimuli with a capsaicin patch on forehead, a mechanical headband, or both were applied prior to sublingual GTN (0.5 mg) in 20 healthy volunteers. GTN-induced headache characteristics and sensory responsiveness were recorded. RESULTS A more intense GTN-evoked headache was produced following application of headband. CONCLUSION Noxious mechanical stimulation prior to GTN resulted in a more intense GTN-evoked headache.
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Affiliation(s)
- Parisa Gazerani
- Department of Health Science & Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Brian Edwin Cairns
- Department of Health Science & Technology, Faculty of Medicine, Aalborg University, Denmark.,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Hanim Yassin
- Department of Health Science & Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Jasmin Tannaz Yousefi
- Department of Health Science & Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Asiah Rahi Sherzaman
- Department of Health Science & Technology, Faculty of Medicine, Aalborg University, Denmark
| | | | - Søren Kjærgaard Boldsen
- Unit of Clinical Biostatistics and Bioinformatics, Aalborg University Hospital North, Aalborg, Denmark
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6
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Dong H, Wang ZH, Dong B, Hu YN, Zhao HY. Endothelial nitric oxide synthase (-786T>C) polymorphism and migraine susceptibility: A meta-analysis. Medicine (Baltimore) 2018; 97:e12241. [PMID: 30200152 PMCID: PMC6133471 DOI: 10.1097/md.0000000000012241] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the correlation between endothelial nitric oxide synthase (eNOS) polymorphism (-786T>C) and migraine susceptibility in a meta-analysis. METHODS A literature search was performed for case-control studies from inception to July 30, 2018 focusing on eNOS polymorphism (-786T>C) and risk of migraine. From 454 full-text articles, 6 were included in this study. Heterogeneity was assessed with the I index and quality assessment was performed using the Newcastle-Ottawa scale. RESULTS CC genotype was not related to higher susceptibility of migraine compared with TT+ TC genotypes with significant difference (fixed effects model; OR = 1.27; 95% CI = 0.90-1.80; P = .17; I = 18%). However, subgroup analysis showed CC variant increase the risk for migraine compared with TT+ TC genotypes in Caucasian populations (fixed effects model; OR = 1.62; 95% CI = 1.03-2.56; P = .04; I = 18%), which could not be observed in non-Caucasian populations (fixed effects model; OR = 0.88; 95% CI = 0.51-1.53; P = .66; I = 0%). There was no significant difference for other genotypes and alleles between patients with migraine and healthy controls (all P > .05). CONCLUSION This meta-analysis indicated that CC variant increases the risk for migraine compared with TT + TC genotypes in Caucasian populations.
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Affiliation(s)
- Han Dong
- Department of Geriatric Medicine, The First Hospital of Jilin University, Changchun
| | - Zhi Hao Wang
- Department of Geriatric Medicine, The First Hospital of Jilin University, Changchun
| | - Bin Dong
- Department of Geriatric Medicine, The First Hospital of Jilin University, Changchun
| | - Ya Nan Hu
- College of Basic Medical Science, Changchun University of Chinese Medicine, Jilin Province, China
| | - Hui Ying Zhao
- Department of Geriatric Medicine, The First Hospital of Jilin University, Changchun
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7
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Olesen ND, Fischer M, Secher NH. Sodium nitroprusside dilates cerebral vessels and enhances internal carotid artery flow in young men. J Physiol 2018; 596:3967-3976. [PMID: 29917239 DOI: 10.1113/jp275887] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/12/2018] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Sodium nitroprusside lowers blood pressure by vasodilatation but is reported to reduce cerebral blood flow. In healthy young men sodium nitroprusside reduced blood pressure, total peripheral resistance, and arterial CO2 tension and yet cerebral blood flow was maintained, with an increase in internal carotid artery blood flow and cerebrovascular conductance. Sodium nitroprusside induces both systemic and cerebral vasodilatation affecting internal carotid artery more than vertebral artery flow. ABSTRACT Cerebral autoregulation maintains cerebral blood flow (CBF) despite marked changes in mean arterial pressure (MAP). Sodium nitroprusside (SNP) reduces blood pressure by vasodilatation but is reported to lower CBF, probably by a reduction in its perfusion pressure. We evaluated the influence of SNP on CBF and aimed for a 20% and then 40% reduction in MAP, while keeping MAP ≥ 50 mmHg, to challenge cerebral autoregulation. In 19 healthy men (age 24 ± 4 years; mean ± SD) duplex ultrasound determined right internal carotid (ICA) and vertebral artery (VA) blood flow. The SNP reduced MAP (from 83 ± 8 to 69 ± 8 and 58 ± 4 mmHg; both P < 0.0001), total peripheral resistance, and arterial CO2 tension (P aC O2; 41 ± 3 vs. 39 ± 3 and 37 ± 4 mmHg; both P < 0.01). Yet ICA flow increased with the moderate reduction in MAP but returned to the baseline value with the large reduction in MAP (336 ± 66 vs. 365 ± 69; P = 0.013 and 349 ± 82 ml min-1 ; n.s.), while VA flow (114 ± 34 vs. 112 ± 38 and 110 ± 42 ml min-1 ; both n.s.) and CBF ((ICA + VA flow) × 2; 899 ± 135 vs. 962 ± 127 and 918 ± 197 ml min-1 ; both n.s.) were maintained with increased cerebrovascular conductance. In conclusion, CBF is maintained during SNP-induced reduction in MAP despite reduced P aC O2 and the results indicate that SNP dilates cerebral vessels and increases ICA flow.
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Affiliation(s)
- Niels D Olesen
- Department of Anaesthesia, The Copenhagen Muscle Research Centre, Rigshospitalet, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Denmark
| | - Mads Fischer
- Department of Anaesthesia, The Copenhagen Muscle Research Centre, Rigshospitalet, Copenhagen, Denmark.,Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Niels H Secher
- Department of Anaesthesia, The Copenhagen Muscle Research Centre, Rigshospitalet, Copenhagen, Denmark
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Magis D, Bendtsen L, Goadsby PJ, May A, Rio MSD, Sandór PS, Kaube H, Sandrini G, Schoonman GG, Schoenen J. Evaluation and Proposal for Optimization of Neurophysiological Tests In Migraine: Part 2—Neuroimaging and The Nitroglycerin Test. Cephalalgia 2016; 27:1339-59. [DOI: 10.1111/j.1468-2982.2007.01435.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neuroimaging methods have been widely used in headache and migraine research. They have provided invaluable information on brain perfusion, metabolism and structure during and outside of migraine attacks, contributing to an improved understanding of the pathophysiology of the disorder. Human models of migraine attacks are indispensable tools in pathophysiological and therapeutic research. This review of neuroimaging methods and the attack-provoking nitroglycerin test is part an initiative by a task force within the EUROHEAD project (EU Strep LSHM-CT-2004-5044837-Workpackage 9) with the objective of critically evaluating neurophysiological tests used in migraine. The first part, presented in a companion paper, is devoted to electrophysiological methods, this second part to neuroimaging methods such as functional magnetic resonance imaging, positron emission tomography and voxel-based morphometry, as well as the nitroglycerin test. For each of these methods, we summarize the results, analyse the methodological limitations and propose recommendations for improved methodology and standardization of research protocols.
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Affiliation(s)
- D Magis
- Headache Research Unit, Department of Neurology, University of Liège, Liège, Belgium
| | - L Bendtsen
- Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - PJ Goadsby
- Headache Group, Institute of Neurology, London, UK
| | - A May
- Department of Neurology, University of Hamburg, Hamburg, Germany
| | - M Sánchez del Rio
- Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - PS Sandór
- Headache and Pain Unit, Department of Neurology, University Hospital, Zürich, Switzerland
| | - H Kaube
- Headache Group, Institute of Neurology, London, UK
| | - G Sandrini
- University Centre for Adaptive Disorders and Headache, IRCCS C. Mondino Institute of Neurology Foundation, University of Pavia, Pavia, Italy
| | - GG Schoonman
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Schoenen
- Headache Research Unit, Department of Neurology, University of Liège, Liège, Belgium
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Carl J, Tideman DA, Ravn S, Lund K, Magnisdottir SO, Kjærgaard B. Intravenous Infusion of Nitroglycerine Leads to Increased Permeability on Dynamic Contrast-Enhanced MR Imaging in Pig Brains. AJNR Am J Neuroradiol 2015; 36:1288-92. [PMID: 25814659 DOI: 10.3174/ajnr.a4279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/02/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE It has been suggested that off-label use of transdermal nitroglycerine patches to prevent frostbite may lead to severe acute mountain sickness and ataxia. The aim of this study was to investigate the effect of nitroglycerine on brain vascular permeability by using dynamic contrast-enhanced MR imaging in a swine model. MATERIALS AND METHODS Eight Danish Landrace-Yorkshire-Danish Landrace pigs of approximately 20-25 kg were scanned with a dynamic contrast-enhanced MR perfusion protocol with and without nitroglycerine intravenous infusion. Compartmental analysis was performed on the basis of the Tofts model, and voxel-based quantitative values of the volume transfer constants from the vascular to the extracellular space were determined. RESULTS The scan with nitroglycerine infusion resulted in significantly higher volume transfer constant values than values derived from the first scan without nitroglycerine infusion. Increased volume transfer constant values were observed in 6 of 8 animals. CONCLUSIONS Infusion of nitroglycerine increases the vascular permeability of the swine brain on the basis of the transfer constant estimated from dynamic contrast-enhanced MR imaging.
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Affiliation(s)
- J Carl
- From the Department of Medical Physics, Oncology (J.C., D.A.T., S.R., K.L.)
| | - D A Tideman
- From the Department of Medical Physics, Oncology (J.C., D.A.T., S.R., K.L.)
| | - S Ravn
- From the Department of Medical Physics, Oncology (J.C., D.A.T., S.R., K.L.)
| | - K Lund
- From the Department of Medical Physics, Oncology (J.C., D.A.T., S.R., K.L.)
| | - S O Magnisdottir
- Biomedical Research Laboratory (S.O.M., B.K.), Aalborg University Hospital, Aalborg, Denmark
| | - B Kjærgaard
- Biomedical Research Laboratory (S.O.M., B.K.), Aalborg University Hospital, Aalborg, Denmark
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10
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Erkan H, Kırış G, Korkmaz L, Ağaç MT, Çavuşoğlu İG, Dursun İ, Yılmaz AS, Aslan AO, Kırcı DC, Çelik Ş. Relationship between Nitrate-Induced Headache and Coronary Artery Lesion Complexity. Med Princ Pract 2015; 24:560-4. [PMID: 26160139 PMCID: PMC5588274 DOI: 10.1159/000434754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/03/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the association between nitrate-induced headache (NIH) and the complexity of coronary artery lesions in patients with stable coronary artery disease (CAD). SUBJECTS AND METHODS Two hundred and seventy-five patients with anginal chest pain who underwent coronary angiography were enrolled in the present study. NIH was defined as the presence of headache due to nitrate treatment (isosorbide mononitrate 40 mg) after excluding confounding factors. Coronary artery lesion complexity was assessed by the SYNTAX score (SXscore) using a dedicated computer software system. RESULTS The mean SXscore was lower in the patients with NIH than in patients without NIH (7.3 ± 5.2 vs. 14.4 ± 8.5, respectively; p < 0.001). Additionally, patients with NIH had a lower rate of multivessel disease compared with those without NIH (the mean number of diseased vessels was 1.5 ± 0.7 and 2.0 ± 07, respectively; p < 0.001). In multivariate analysis, increasing age (p = 0.02) and headache (p = 0.001) were found to be independent determinants of SXscore. CONCLUSION The present study demonstrated an independent inverse association between NIH and SXscore. The NIH could provide important predictive information about coronary artery lesion complexity in patients with stable CAD.
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Affiliation(s)
- Hakan Erkan
- Department of Cardiology, Trabzon, Turkey
- *Hakan Erkan, MD, Department of Cardiology, Ahi Evren Cardiovascular and, Thoracic Surgery Training and Research Hospital, çamlýk Street, TR-61400 Trabzon (Turkey), E-Mail
| | | | | | | | - İsmail Gökhan Çavuşoğlu
- Department of Radiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
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11
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Erdener SE, Dalkara T. Modelling headache and migraine and its pharmacological manipulation. Br J Pharmacol 2014; 171:4575-94. [PMID: 24611635 DOI: 10.1111/bph.12651] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/13/2014] [Accepted: 02/14/2014] [Indexed: 12/22/2022] Open
Abstract
Similarities between laboratory animals and humans in anatomy and physiology of the cephalic nociceptive pathways have allowed scientists to create successful models that have significantly contributed to our understanding of headache. They have also been instrumental in the development of novel anti-migraine drugs different from classical pain killers. Nevertheless, modelling the mechanisms underlying primary headache disorders like migraine has been challenging due to limitations in testing the postulated hypotheses in humans. Recent developments in imaging techniques have begun to fill this translational gap. The unambiguous demonstration of cortical spreading depolarization (CSD) during migraine aura in patients has reawakened interest in studying CSD in animals as a noxious brain event that can activate the trigeminovascular system. CSD-based models, including transgenics and optogenetics, may more realistically simulate pain generation in migraine, which is thought to originate within the brain. The realization that behavioural correlates of headache and migrainous symptoms like photophobia can be assessed quantitatively in laboratory animals, has created an opportunity to directly study the headache in intact animals without the confounding effects of anaesthetics. Headache and migraine-like episodes induced by administration of glyceryltrinitrate and CGRP to humans and parallel behavioural and biological changes observed in rodents create interesting possibilities for translational research. Not unexpectedly, species differences and model-specific observations have also led to controversies as well as disappointments in clinical trials, which, in return, has helped us improve the models and advance our understanding of headache. Here, we review commonly used headache and migraine models with an emphasis on recent developments.
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Affiliation(s)
- S E Erdener
- Department of Neurology, Faculty of Medicine, Institute of Neurological Sciences and Psychiatry, Hacettepe University, Ankara, Turkey
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12
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Greco R, Meazza C, Mangione AS, Allena M, Bolla M, Amantea D, Mizoguchi H, Sandrini G, Nappi G, Tassorelli C. Temporal profile of vascular changes induced by systemic nitroglycerin in the meningeal and cortical districts. Cephalalgia 2010; 31:190-8. [PMID: 20693231 DOI: 10.1177/0333102410379887] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Clinical studies indicated that nitric oxide (NO) donors cause regional changes in cerebral blood flow (CBF), similar to those reported in spontaneous migraine. Systemic nitroglycerin (NTG), a NO donor, is a well-accepted experimental model of migraine. In this study we have examined the effects of NTG on the meningeal and cortical blood flow in rats. METHODS Regional blood flow was monitored in male Sprague-Dawley rats using laser Doppler flowmetry before and after NTG/saline injection over 150 minutes. The effect of pre-treatment with Nω-nitro-L-arginine ester (L-NAME) or 7-nitroindazole (7-NI) on NTG-induced changes on blood flow was also investigated. RESULTS In the dura NTG caused a biphasic response represented by an initial decrease in blood flow followed by a significant increase. At variance, in the cortex NTG caused only an increase in blood flow. Pre-treatment with either L-NAME or 7-NI prevented NTG-induced increase in blood flow in both districts, while only L-NAME also prevented NTG-induced decrease in dural blood flow. CONCLUSION The present findings provide additional information on the timing of effects of NTG on blood flow at both the meningeal and cortical levels. These effects seem to be related to vasoregulatory mechanisms and/or metabolic activity in response to the synthesis of endogenous NO.
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Affiliation(s)
- Rosaria Greco
- IRCCS National Neurological Institute C. Mondino Foundation, Pavia, Italy.
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Tfelt-Hansen PC, Tfelt-Hansen J. Nitroglycerin headache and nitroglycerin-induced primary headaches from 1846 and onwards: a historical overview and an update. Headache 2009; 49:445-56. [PMID: 19267787 DOI: 10.1111/j.1526-4610.2009.01342.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nitroglycerin (NTG) (glyceryl trinitrate) was synthesized by the Italian chemist Ascanio Sobrero in Paris in 1846. A very unstable explosive, Alfred Nobel while working on explosives, combined it with Kiselguhr and patented it as dynamite in 1867. NTG was introduced in 1879 in medicine in the treatment of angina pectoris by the English doctor William Murrell. NTG-induced headache was quickly recognized as an important adverse event both in the industrial use of NTG, where it was used to produce dynamite, as well as in the use of NTG as drug. This review traces the evolution of our understanding of NTG headache.
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Affiliation(s)
- Peer C Tfelt-Hansen
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark
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New insights into headache: an update on functional and structural imaging findings. Nat Rev Neurol 2009; 5:199-209. [DOI: 10.1038/nrneurol.2009.28] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nitric oxide-induced headache may arise from extracerebral arteries as judged from tolerance to isosorbide-5-mononitrate. J Headache Pain 2008; 9:215-20. [PMID: 18521538 PMCID: PMC3451949 DOI: 10.1007/s10194-008-0043-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 05/05/2008] [Indexed: 11/24/2022] Open
Abstract
Long-term exposure to organic nitrates influences different sections of the vascular bed heterogeneously. Continuous dosage of nitrates leads to the development of tolerance both to the vascular effects and to the unwanted adverse effect, headache. Human data on the development of tolerance in different cranial arteries over more than 24 h are lacking. We compared the vascular changes of the middle cerebral, superficial temporal and radial arteries during oral administration of isosorbide-5-mononitrate (5-ISMN) 30 mg three times daily for 7 days in 11 healthy subjects in a double-blind, randomised, placebo controlled cross-over design. Blood velocity in the middle cerebral artery was measured with transcranial Doppler and the diameters of the temporal and radial arteries were measured with high frequency ultrasound. Headache recordings were compared to the observed vascular changes over time. Tolerance was complete within 24 h in the middle cerebral artery whilst in the superficial temporal and the radial arteries, tolerance was only partial and developed much more slowly, i.e. after 7 days correlating with the disappearance of NO-induced headache. The present study thus demonstrated the important differences in the time profiles of appearance of nitrate tolerance in arteries of different vascular beds in man. If vasodilatation is the cause of NO-induced headache the results point to extracerebral arteries as the locus of nociception. Due to a variety of other possible pain-inducing effects of nitric oxide our results do not exclude cerebral arteries.
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Iversen HK, Holm S, Friberg L, Tfelt-Hansen P. Intracranial hemodynamics during intravenous infusion of glyceryl trinitrate. J Headache Pain 2008; 9:177-80. [PMID: 18401549 PMCID: PMC3476195 DOI: 10.1007/s10194-008-0034-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 03/25/2008] [Indexed: 01/24/2023] Open
Abstract
The mechanisms of glyceryl trinitrate (GTN)-induced headache are not fully elucidated. In this study we administered GTN 0.5 μg/kg/min i.v. for 20 min in six healthy volunteers. Before, during and 60 min after the infusion, we investigated regional cerebral blood flow (rCBF), cerebral blood volume (CBV), both estimated with SPECT, and blood flow velocity (BFV) in the middle cerebral artery (MCA), measured with transcranial Doppler. Headache was scored on a numerical verbal rating (0–10) scale. rCBF was unchanged, CBV was slightly increased (13%) during GTN infusion, whereas BFV decreased both during (20%) and 60 min (15%) after GTN. Headache was short-lived and maximal during infusion. This discrepancy of time-effect curves for the effect of GTN on headache and dilatation of MCA indicates that MCA is most likely not the primary source of pain in GTN-induced headache. The time-effect curves for the effect of GTN on headache and on dilation of MCA differed markedly. This indicates that MCA is most likely not the primary source of pain in GTN-induced headache.
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Affiliation(s)
- H K Iversen
- Department of Neurology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark
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Moppett IK, Sherman RW, Wild MJ, Latter JA, Mahajan RP. Effects of norepinephrine and glyceryl trinitrate on cerebral haemodynamics: transcranial Doppler study in healthy volunteers. Br J Anaesth 2008; 100:240-4. [PMID: 18211997 DOI: 10.1093/bja/aem374] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The effects of vasoactive substances on cerebral haemodynamics are not fully known. We studied the effects of norepinephrine and glyceryl trinitrate (GTN) on cerebral haemodynamics in healthy volunteers. METHODS The effects of norepinephrine (n=10) and GTN (n=10) on the middle cerebral artery flow velocity (MCAFV), cerebral autoregulation, reactivity to carbon dioxide, and estimated cerebral perfusion pressure (eCPP) were studied using transcranial Doppler ultrasound. Established methods were used for calculating zero flow pressure (ZFP). Measurements were made at baseline, and after i.v. infusion of the study drug to the endpoints of 25% increase in mean arterial pressure (MAP) for norepinephrine (0.02-0.1 microg kg(-1) min(-1)), or 15% decrease in MAP for GTN (0.5-2.5 microg kg(-1) min(-1)). RESULTS The MCAFV remained unchanged with norepinephrine, but decreased slightly with GTN {from [median (inter-quartile range)] 53 (38, 62) to 48 (33, 52) cm s(-1)}. Cerebrovascular reactivity did not change significantly with either drug. The eCPP did not change significantly with norepinephrine, but increased significantly with GTN [from 49 (32, 54) to 62 (47, 79) mm Hg]. ZFP increased with norepinephrine [from 39 (28, 48) to 56 (46, 62) mm Hg] and decreased with GTN [from 35 (30, 49) to 12 (-7, 20) mm Hg]. CONCLUSIONS Norepinephrine, despite increasing arterial pressure, did not increase the eCPP. The eCPP increased significantly with GTN, despite decreased MAP. Cerebral vascular tone is an important determinant of CPP during pharmacologically induced changes in arterial pressure.
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Affiliation(s)
- I K Moppett
- University Department of Anaesthesia and Intensive Care, Queen's Medical Centre, Nottingham, UK.
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Kassab MY, Majid A, Bakhtar O, Farooq MU, Patel K, Bednarczyk EM. Transcranial Doppler measurements in migraine and nitroglycerin headache. J Headache Pain 2007; 8:289-93. [PMID: 17955171 PMCID: PMC3476155 DOI: 10.1007/s10194-007-0413-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Accepted: 09/14/2007] [Indexed: 12/04/2022] Open
Abstract
The objective of this study was to examine the cerebral circulation during spontaneous migraine attacks and to compare changes to an experimental headache model induced by nitroglycerin (NTG) infusion. This prospective study was carried out in a tertiary care hospital on migraineurs with or without aura. Healthy volunteers served as controls. There were no interventions. Flow velocity (FV) and pulsatility index (PI) were measured in migraineurs between and during headache attacks. In controls, FV and PI of the middle cerebral arteries were performed at baseline and after each IV infusion of 0.125, 0.25 and 0.5 microg/kg/min of NTG. In migraineurs, a significant increase in the mean flow velocity (MFV) in the left vertebral artery (VA) and the PI of the right VA during spontaneous migraine headache was found. In controls, all FV significantly decreased after infusion of NTG. The NTG model produces expected and substantially different vascular effects than those seen with spontaneous migraine headache.
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Affiliation(s)
- Mounzer Y Kassab
- Department of Neurology, Michigan State University, 138 Service Road, A-217, East Lansing, MI 48824, USA.
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Hansen JM, Pedersen DL, Larsen VA, Sánchez-del-Rio M, Alvarez Linera JR, Olesen J, Ashina M. Magnetic resonance angiography shows dilatation of the middle cerebral artery after infusion of glyceryl trinitrate in healthy volunteers. Cephalalgia 2007; 27:118-27. [PMID: 17257231 DOI: 10.1111/j.1468-2982.2006.01257.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Previous studies have reported dilatation of the middle cerebral artery (MCA) during acute glyceryl trinitrate (GTN)-induced headache, using imaging techniques such as transcranial Doppler (TCD), positron emission tomography (PET) and single photon emission computerized tomography (SPECT). In the present study we aimed to evaluate whether magnetic resonance angiography (MRA) may be used to examine the effect of GTN on the MCA, with respect to changes in diameter and cross-sectional area in healthy volunteers. In addition, we wanted to determine the intra- and inter-observer variation of the method. In a randomized, double blind, crossover study 12 healthy volunteers received intravenous infusion of GTN (0.5 microg/kg/min for 20 min) or placebo. Using 1.5 Tesla MRA, we recorded changes in the diameter and cross-sectional area of MCA before, during and after infusion of GTN. The MRA images were evaluated by two blinded, independent observers/neuroradiologists. The primary endpoints were the differences in the AUC for diameter and cross-sectional area of the MCA between the two experimental conditions and the intra- and inter-observer variation. The areas under the curve (AUC) of the MCA diameter and cross-sectional area were significantly greater after GTN than after placebo (P < 0.05). The intra-observer variation (day-to-day) at baseline was 8.3% and 10.9% for the two observers. The mean inter-observer variation of the cross-sectional MCA area was 15.5% and for the diameter measurements 8%. The present study shows that the MRA method gives a reliable semi-quantitative index of the vascular changes in the intra-cerebral arteries after infusion of GTN and may be useful for headache research.
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Affiliation(s)
- J M Hansen
- Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
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Schoonman GG, Bakker D, Schmitz N, van der Geest RJ, van der Grond J, Ferrari MD, van Buchem MA. Magnetic resonance angiography of the human middle meningeal artery: implications for migraine. J Magn Reson Imaging 2007; 24:918-21. [PMID: 16958062 DOI: 10.1002/jmri.20708] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To describe a novel noninvasive method for studying middle meningeal artery (MMA) diameter changes in vivo in humans. Dilatation of the MMA has been implicated in the pathophysiology of migraine headache, but no direct evidence has been obtained in humans. MATERIALS AND METHODS The diameter of the MMA (the extracranial part) was measured in 19 healthy volunteers before and after administration of a vasodilator (nitroglycerin (NTG), 1.2 mg sublingually) known to provoke headache. We used magnetic resonance angiography (MRA) in combination with a 47-mm microscopy coil and a semiautomatic contour detection program. RESULTS The diameter of the MMA was 1.5+/-0.26 mm (mean+/-SD) before and 1.79+/-0.30 mm after NTG administration. This increase was 20.1% (95% CI=12.9-27.3; P<0.001). The mean increase in subjects who developed headache (N=11) was 0.34+/-0.19 mm as compared to 0.22 mm+/-0.20 mm in the eight subjects who did not (95% CI for difference=-0.07 to 0.31; P=0.188). CONCLUSION MRA in combination with a 47-mm microscopy coil is a novel, noninvasive method to measure changes in the diameter of human meningeal vessels, with potential applications for migraine and other fields of neurovascular research.
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Affiliation(s)
- Guus G Schoonman
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.
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