1
|
Al-Karagholi MAM, Kalatharan V, Ghanizada H, Gram C, Dussor G, Ashina M. Prolactin in headache and migraine: A systematic review of clinical studies. Cephalalgia 2023; 43:3331024221136286. [PMID: 36718026 DOI: 10.1177/03331024221136286] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To systemically review clinical studies investigating the role of prolactin and its receptors in headache and migraine. BACKGROUND Migraine prevalence is more common in women compared to men. As prolactin is a crucial regulator of the hypothalamus-pituitary-gonadal axis, prolactin and its receptors might contribute to signaling mechanisms underlying migraine. METHODS In this systematic review, we searched PubMed and EMBASE with the terms: prolactin, hyperprolactinemia, macroprolactinemia, hypoprolactinemia, migraine, headache, head pain and trigeminal pain pathway for clinical studies investigating prolactin signaling in headache and migraine. Two reviewers independently screened 841 articles for population, intervention, comparison, outcome, and study design. Studies were restricted to the English language and were excluded if they had a nonexperimental methodology. RESULTS Nineteen clinical studies met the inclusion criteria and were included in the qualitative and quantitative analysis. The main findings were that serum prolactin levels were found to be higher in individuals with migraine compared to healthy controls, and prolactinomas (prolactin-secreting pituitary adenomas) were correlated with higher incidence of headache in otherwise healthy individuals and migraine attacks in individuals with migraine. CONCLUSION Considerable evidence suggests a key role of prolactin and its receptors in migraine pathophysiology. Further randomized and placebo-controlled clinical studies targeting prolactin signaling are needed to further clarify influences of prolactin in migraine attack initiation.
Collapse
Affiliation(s)
- Mohammad Al-Mahdi Al-Karagholi
- Danish Headache Center, Department of Neurology, Rigshospitalet- Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Veberka Kalatharan
- Danish Headache Center, Department of Neurology, Rigshospitalet- Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Hashmat Ghanizada
- Danish Headache Center, Department of Neurology, Rigshospitalet- Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Christian Gram
- Danish Headache Center, Department of Neurology, Rigshospitalet- Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Gregory Dussor
- School of Behavioral and Brain Sciences, Center for Advanced Pain Studies, The University of Texas at Dallas, Richardson, USA
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet- Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark.,Danish Headache Knowledge Center on Headache Disorders, Rigshospitalet - Glostrup, Glostrup, Denmark
| |
Collapse
|
2
|
Khan FA, McIntyre C, Khan AM, Maslov A. Headache and Methemoglobinemia. Headache 2019; 60:291-297. [PMID: 31724752 DOI: 10.1111/head.13696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2019] [Indexed: 11/27/2022]
Abstract
AIM This basic review is intended to summarize the current knowledge of methemoglobinemia as an important cause of secondary headache with the hope of generating a growing interest in studying this phenomenon. BACKGROUND We describe the pathological underpinnings of headaches generated by hypoxia. Possible mechanisms include cerebral vasodilation-associated stretching of the vessel nociceptors, sensitization of perivascular nociceptors mediated by nitric oxide, cerebral calcitonin gene-related peptide, activation of the cyclic adenosine monophosphate pathway, cortical spreading depression, disruption of the blood-brain barrier, and neurogenic inflammation. We review the clinical features, pathophysiology, and management of methemoglobinemia. We conducted a literature review of reports of symptomatic methemoglobinemia with headache. In addition, we describe a case report of a patient who presented with an acute onset of severe holocranial headache associated with rapidly progressive perioral paresthesia, cyanosis in lips and hands, nausea, and mild dyspnea on exertion. These features can be misinterpreted as an acute attack of migraine with pain-related hyperventilation syndrome and anxiety leading to clinically detrimental delay in the management of the progressive hypoxia. Her symptoms resolved following treatment with methylene blue. The complex relationship of migraine and hypoxia-related headaches is also reviewed. We propose that methemoglobinemia-associated headaches are possibly generated by stretching of the nociceptor nerve endings during cerebral vasodilation and hypoxia-mediated oxidative stress. CONCLUSIONS The case highlights the need to broaden the formulated differential diagnosis of an acute onset severe holocranial headache and pay careful attention to other signs and symptoms that may provide hints on potential mechanism(s) for secondary headaches. We provide justification for the need to incorporate "Headache attributed to Methemoglobinemia" as a subtype under the section "Headache attributed to hypoxia and/or hypercapnia" of the International Classification of Headache Disorders to support clinical decision making.
Collapse
Affiliation(s)
- Fawad Ahmed Khan
- The McCasland Family Comprehensive Headache Center, Ochsner Neuroscience Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, USA.,Tulane University School of Medicine, New Orleans, LA, USA
| | - Caley McIntyre
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, USA.,Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Abdul Mukhtadir Khan
- Department of Pulmonary and Critical Care Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Alexander Maslov
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, USA
| |
Collapse
|
3
|
Abstract
Background Hypoxia causes secondary headaches such as high-altitude headache (HAH) and headache due to acute mountain sickness. These secondary headaches mimic primary headaches such as migraine, which suggests a common link. We review and discuss the possible role of hypoxia in migraine and cluster headache. Methods This narrative review investigates the current level of knowledge on the relation of hypoxia in migraine and cluster headache based on epidemiological and experimental studies. Findings Epidemiological studies suggest that living in high-altitude areas increases the risk of migraine and especially migraine with aura. Human provocation models show that hypoxia provokes migraine with and without aura, whereas cluster headache has not been reliably induced by hypoxia. Possible pathophysiological mechanisms include hypoxia-induced release of nitric oxide and calcitonin gene-related peptide, cortical spreading depression and leakage of the blood-brain barrier. Conclusion There is a possible link between hypoxia and migraine and maybe cluster headache, but the exact mechanism is currently unknown. Provocation models of hypoxia have yielded interesting results suggesting a novel approach to study in depth the mechanism underlying hypoxia and primary headaches.
Collapse
Affiliation(s)
- Josefine Britze
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Nanna Arngrim
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Henrik Winther Schytz
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| |
Collapse
|
4
|
Arngrim N, Schytz HW, Britze J, Amin FM, Vestergaard MB, Hougaard A, Wolfram F, de Koning PJH, Olsen KS, Secher NH, Larsson HBW, Olesen J, Ashina M. Migraine induced by hypoxia: an MRI spectroscopy and angiography study. Brain 2015; 139:723-37. [DOI: 10.1093/brain/awv359] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/16/2015] [Indexed: 01/03/2023] Open
|
5
|
Davidai G, Cotton D, Gorelick P, Bath PMW, Lipton RB, Sacco R, Diener HC. Dipyridamole-induced headache and lower recurrence risk in secondary prevention of ischaemic stroke: a post hoc analysis. Eur J Neurol 2014; 21:1311-7. [PMID: 25040015 DOI: 10.1111/ene.12484] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 05/05/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Our objective was to investigate the association between recurrent stroke risk and headache induced by extended-release dipyridamole (ER-DP) when administered alone or with low-dose aspirin (ASA+ER-DP). METHODS This was a post hoc analysis of prospectively collected data on recurrent stroke risk and headache as an adverse event or reason for treatment discontinuation from the PRoFESS (N = 20,332) and ESPS2 (N = 6602) trials. Hazard ratios (HRs) for recurrent stroke were calculated using the Cox model. RESULTS In PRoFESS, the 2.5-year recurrent stroke risk in patients receiving ASA+ER-DP was 8.2% in those with headache within 7 days of starting treatment and 9.4% in those without [HR 0.85, 95% confidence interval (CI) 0.73-0.98; P = 0.03]. Recurrent stroke risk was 5.0% in patients who discontinued ASA+ER-DP due to headache by day 90 versus 9.2% in those who did not (HR 0.52, 95% CI 0.35-0.77; P = 0.001). No such difference was observed in clopidogrel-treated patients. In ESPS2, risk of recurrent stroke was 6.2% in patients who discontinued ASA+ER-DP due to headache by day 90 versus 9.8% in patients who did not (HR 0.62, 95% CI 0.31-1.27; P = 0.19) and 7.3% in patients who discontinued ER-DP due to headache by day 90 versus 13.2% in those who did not (HR 0.53, 95% CI 0.27-1.04; P = 0.06). CONCLUSIONS Patients taking ASA+ER-DP in PRoFESS who developed headache had significantly reduced stroke recurrence risk versus those without headache. Similar (non-significant) findings for ASA+ER-DP and ER-DP in ESPS2 suggest that dipyridamole-induced headache may reflect better cerebrovascular function.
Collapse
Affiliation(s)
- G Davidai
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | | | | | | | | | | | | |
Collapse
|
6
|
Amin FM, Hougaard A, Schytz HW, Asghar MS, Lundholm E, Parvaiz AI, de Koning PJH, Andersen MR, Larsson HBW, Fahrenkrug J, Olesen J, Ashina M. Investigation of the pathophysiological mechanisms of migraine attacks induced by pituitary adenylate cyclase-activating polypeptide-38. Brain 2014; 137:779-94. [DOI: 10.1093/brain/awt369] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
7
|
Henriksen OM, Kruuse C, Olesen J, Jensen LT, Larsson HBW, Birk S, Hansen JM, Wienecke T, Rostrup E. Sources of variability of resting cerebral blood flow in healthy subjects: a study using ¹³³Xe SPECT measurements. J Cereb Blood Flow Metab 2013; 33:787-92. [PMID: 23403374 PMCID: PMC3652692 DOI: 10.1038/jcbfm.2013.17] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Measurements of cerebral blood flow (CBF) show large variability among healthy subjects. The aim of the present study was to investigate the relative effect of established factors influencing CBF on the variability of resting CBF. We retrospectively analyzed spontaneous variability in 430 CBF measurements acquired in 152 healthy, young subjects using (133)Xe single-photon emission computed tomography. Cerebral blood flow was correlated positively with both end-tidal expiratory PCO₂ (PETCO₂) and female gender and inversely with hematocrit (Hct). Between- and within-subject CO₂ reactivity was not significantly different. Including PETCO₂, Hct and gender in the model reduced between-subject and within-subject variance by 14% and 13.5%, respectively. Within-subject variability was mainly influenced by PETCO₂ and between-subject variability mostly by Hct, whereas gender appeared to be of little added value when Hct was also accounted for. The present study confirms large between-subject variability in CBF measurements and that gender, Hct, and PETCO₂ explain only a small part of this variability. This implies that a large fraction of CBF variability may be due to unknown factors such as differences in neuron density or metabolism that could be subject for further studies.
Collapse
Affiliation(s)
- Otto M Henriksen
- Functional Imaging Unit, Department of Diagnostics, Glostrup University Hospital, Glostrup, Denmark.
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
|
9
|
Shafy A, Molinié V, Cortes-Morichetti M, Hupertan V, Lila N, Chachques JC. Comparison of the effects of adenosine, inosine, and their combination as an adjunct to reperfusion in the treatment of acute myocardial infarction. ISRN CARDIOLOGY 2012; 2012:326809. [PMID: 22462024 PMCID: PMC3312546 DOI: 10.5402/2012/326809] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 12/22/2011] [Indexed: 11/23/2022]
Abstract
Adenosine and inosine are both key intracellular energy substrates for nucleotide synthesis by salvage pathways, especially during ischemic stress conditions. Additionally they both possess cell protective and cell repair properties. The objective of this study is to detect potential advantages of the combination of adenosine and inosine versus each drug alone, in terms of ventricular function, infarct size reduction and angiogenesis. Myocardial ischemia was created in rodents and treated with adenosine, inosine or their combination. Results of experiments showed that the combination of both drugs significantly reduced infarct size and improved myocardial angiogenesis and ventricular function. The two compounds, while chemically similar, use different intracellular pathways, allowing for complementary biological activities without overlapping. The drug combination at specific 1 : 5 adenosine : inosine dose ratio demonstrated positive cardiologic effects, deserving further evaluation as an adjunct to reperfusion techniques during and after acute coronary syndrome. The association of adenosine and inosine may contribute to reduce myocardial infarction morbidity and mortality rates.
Collapse
Affiliation(s)
- Abdel Shafy
- Laboratory of Biosurgical Research, Alain Carpentier Foundation, University Paris Descartes, 75015 Paris, France
| | | | | | | | | | | |
Collapse
|
10
|
Olesen J, Ashina M. Emerging migraine treatments and drug targets. Trends Pharmacol Sci 2011; 32:352-9. [PMID: 21459461 DOI: 10.1016/j.tips.2011.02.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 02/24/2011] [Accepted: 02/24/2011] [Indexed: 12/27/2022]
Abstract
Migraine has a 1-year prevalence of 10% and high socioeconomic costs. Despite recent drug developments, there is a huge unmet need for better pharmacotherapy. In this review we discuss promising anti-migraine strategies such as calcitonin gene-related peptide (CGRP) receptor antagonists and 5-hydroxytrypamine (5-HT)(1F) receptor agonists, which are in late-stage development. Nitric oxide antagonists are also in development. New forms of administration of sumatriptan might improve efficacy and reduce side effects. Botulinum toxin A has recently been approved for the prophylaxis of chronic migraine. Tonabersat, a cortical spreading depression inhibitor, has shown efficacy in the prophylaxis of migraine with aura. Several new drug targets such as nitric oxide synthase, the 5-HT(1D) receptor, the prostanoid receptors EP(2) and EP(4), and the pituitary adenylate cyclase receptor PAC1 await development. The greatest need is for new prophylactic drugs, and it seems likely that such compounds will be developed in the coming decade.
Collapse
Affiliation(s)
- Jes Olesen
- Danish Headache Center & Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Ndr. Ringvej 57, DK-2600 Glostrup, Denmark.
| | | |
Collapse
|
11
|
Wienecke T, Olesen J, Ashina M. Discrepancy between strong cephalic arterial dilatation and mild headache caused by prostaglandin D2 (PGD2). Cephalalgia 2010; 31:65-76. [DOI: 10.1177/0333102410373156] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Prostaglandins (PGs) are involved in nociception and mast cell degranulation. Prostaglandin D2 (PGD2) is a vasodilatator released during mast cell degranulation. The headache-eliciting effect of PGD2 has not been studied in man. Subjects and methods: Twelve healthy volunteers were randomly allocated to receive intravenous infusion of 384 ng/kg/min PGD2 over 25 min in a placebo-controlled, double-blind cross-over study. We recorded headache intensity and associated symptoms, velocity in the middle cerebral artery (VMCA) and diameter of the superficial temporal artery (STA) and radial artery (RA) using ultrasonography. Results: In the period 0–14 h, 11 subjects reported headache on PGD2 compared to one subject on placebo ( P = 0.002). During the in-hospital phase (0–120 min), the area under the headache curve was larger on PGD2 compared to placebo ( P < 0.05). Median peak headache, 1 (0–1), occurred 10 min after start of PGD2 infusion. There was no difference in incidence of headache in the post-hospital phase between PGD2 ( n = 3) and placebo ( n = 1). There was a decrease in VMCA ( P < 0.001), increase in STA ( P < 0.001) and RA ( P < 0.006) diameter during PGD2 infusion compared to placebo. Peak decrease in VMCA was 28.3% after 10 min and peak increase in STA was 55.7% after 20 min on the PGD2 day. Conclusions: The present study shows that PGD2 is a very strong vasodilator of MCA, STA and RA, but causes only mild headache.
Collapse
|
12
|
Olesen J, Tfelt-Hansen P, Ashina M. Finding New Drug Targets for the Treatment of Migraine Attacks. Cephalalgia 2009; 29:909-20. [DOI: 10.1111/j.1468-2982.2008.01837.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
No new preventive drugs specific to migraine have appeared for the last 20 years and existing acute therapies need improvement. Unfortunately, no animal models can predict the efficacy of new therapies for migraine. Because migraine attacks are fully reversible and can be aborted by therapy, the headache- or migraine-provoking property of naturally occurring signalling molecules can be tested in a human model. This model has predicted efficacy of nitric oxide synthase inhibition and calcitonin gene-related peptide receptor blockade. The pharmaceutical industry should pay more attention to human models, although methods are different from normal target validation.
Collapse
Affiliation(s)
- J Olesen
- Danish Headache Centre and Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Tfelt-Hansen
- Danish Headache Centre and Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M Ashina
- Danish Headache Centre and Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
13
|
Panconesi A, Bartolozzi ML, Guidi L. Migraine pain: reflections against vasodilatation. J Headache Pain 2009; 10:317-25. [PMID: 19499287 PMCID: PMC3452097 DOI: 10.1007/s10194-009-0130-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 05/09/2009] [Indexed: 12/28/2022] Open
Abstract
The original Wolff’s vascular theory of migraine was supported by the discovery of a class of drugs, the triptans, developed as a selective cephalic vasoconstrictor agents. Even in the neurovascular hypothesis of Moskowitz, that is the neurogenic inflammation of meningeal vessels provoked by peptides released from trigeminal sensory neurons, the vasodilatation provoked by calcitonin gene-related peptide (CGRP) is considered today much more important than oedema. The role of cephalic vasodilatation as a cause of migraine pain was recently sustained by studies showing the therapeutic effect of CGRP receptor antagonists. We discuss the evidence against vasodilatation as migraine pain generator and some findings which we suggest in support of a central (brain) origin of pain.
Collapse
|
14
|
Lindholt M, Petersen KA, Tvedskov JF, Iversen HK, Olesen J, Tfelt-Hansen P. Lack of Effect of Norepinephrine on Cranial Haemodynamics and Headache in Healthy Volunteers. Cephalalgia 2009; 29:384-7. [DOI: 10.1111/j.1468-2982.2008.01739.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Stress is a provoking factor for both tension-type headache and migraine attacks. In the present single-blind study, we investigated if stress induced by norepinephrine (NE) could elicit delayed headache in 10 healthy subjects and recorded the cranial arterial responses. NE at a dose of 0.025 μg kg−1 min−1 or placebo was infused for 90 min and the headache was followed for 14 h. Blood flow velocit in the middle cerebral artery (measured with transcranial Doppler) and diameters of the temporal artery and the radial artery (measured with ultrasound) were followed for 2 h. There were no changes in these arterial parameters after NE. In both treatment groups three subjects developed delayed headaches. Thus, stress by NE infusion did not result in delayed headache.
Collapse
Affiliation(s)
- M Lindholt
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark
| | - KA Petersen
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark
| | - JF Tvedskov
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark
| | - HK Iversen
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark
| | - J Olesen
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark
| | - P Tfelt-Hansen
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark
| |
Collapse
|
15
|
|
16
|
Low DA, Vu A, Brown M, Davis SL, Keller DM, Levine BD, Crandall CG. Temporal Thermometry Fails to Track Body Core Temperature during Heat Stress. Med Sci Sports Exerc 2007; 39:1029-35. [PMID: 17596768 DOI: 10.1249/mss.0b013e318050ca3e] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of this study was to assess the accuracy of temporal scanning thermometry in monitoring internal temperature increases during passive heating. METHODS Sixteen subjects (5 males and 11 females) underwent a whole-body passive heat stress (water-perfused suit) to increase internal temperature. Temperatures were obtained with a temporal scanner and with an ingestible-pill telemetry system that tracks intestinal temperature. Temperatures were recorded while subjects were normothermic (34 degrees C water-perfusing suit) and every 10 min during passive heating (48 degrees C water-perfusing suit). RESULTS Heart rate (ECG), mean skin temperature (weighted six-site average), skin blood flow (laser Doppler flowmetry), and sweat rate (capacitance hygrometry) were all significantly elevated at the end of heating (all P < 0.001). Pre-heat stress temporal-derived temperature was not different from intestinal temperature (36.98 +/- 0.09 vs 37.01 +/- 0.09 degrees C, respectively, P = 0.76). However, after 30 min of heating (the greatest duration of heating completed by all subjects), temporal-derived temperature decreased to below the pre-heat stress baseline (-0.22 +/- 0.11), whereas intestinal temperature increased by 0.39 +/- 0.07 degrees C (P < 0.001 between the two methods). After 50 min of heating (N = 11), intestinal-derived internal temperature increased by 0.70 +/- 0.09 degrees C, whereas temporal-derived temperature decreased by 0.29 +/- 0.10 degrees C (P < 0.001). The group average (+/- SEM) R2 and slope between the two methods were 0.29 +/- 0.08 and -0.34 +/- 0.14, respectively. CONCLUSION These results demonstrate that temporal scanning does not track internal temperature, as measured via intestinal temperature, during passive heating. Given these findings, it is recommended that this technique not be used to assess temperature in hyperthermic diaphoretic subjects.
Collapse
Affiliation(s)
- David A Low
- Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas, Dallas, TX 75231, USA
| | | | | | | | | | | | | |
Collapse
|
17
|
|
18
|
Birk S, Kruuse C, Petersen KA, Tfelt-Hansen P, Olesen J. The headache-inducing effect of cilostazol in human volunteers. Cephalalgia 2006; 26:1304-9. [PMID: 17059437 DOI: 10.1111/j.1468-2982.2006.01218.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We have previously shown that nitric oxide (NO) and cyclic guanosine monophosphate (GMP) may cause headache and migraine. However, not all findings in previous studies can be explained by an activation of the NO-cGMP pathway. Calcitonin gene-related peptide (CGRP) causes headache and migraine in migraine patients, but CGRP receptor activation causes an increase in cyclic adenosine monophosphate (cAMP). In order to investigate the role of cAMP in vascular headache pathogenesis, we studied the effect of cilostazol, an inhibitor of cAMP degradation, in our human experimental headache model. Twelve healthy volunteers were included in a double-blind, randomized, crossover study. Placebo or cilostazol (200 mg p.o.) was administered on two separate study days. Headache was scored on a verbal rating scale (0-10) and mechanical pain thresholds were measured with von Frey hairs. The median peak headache score 0-16 h postdose was 0 (range 0-2) after placebo and 3.5 (range 0-7) after cilostazol (P = 0.003). The median headache curve peaked at 6-9 h postdose. The headaches induced were usually bilateral and pulsating. Nausea occurred in two volunteers, photo- and phonophobia were not seen. Two volunteers had a headache that fulfilled International Headache Society criteria for migraine without aura after cilostazol. No change in mechanical pain thresholds in the forehead was seen (P = 0.25). The headache after cilostazol was equal to or more severe than headache induced by glyceryl trinitrate in previous experiments. The present study thus indicates that increased levels of cAMP may play a role in headache and migraine pathogenesis.
Collapse
Affiliation(s)
- S Birk
- Danish Headache Centre and Department of Neurology, University of Copenhagen, Glostrup University Hospital, Copenhagen, Denmark.
| | | | | | | | | |
Collapse
|
19
|
Kruuse C, Lassen LH, Iversen HK, Oestergaard S, Olesen J. Dipyridamole may induce migraine in patients with migraine without aura. Cephalalgia 2006; 26:925-33. [PMID: 16886928 DOI: 10.1111/j.1468-2982.2006.01137.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Dipyridamole inhibits phosphodiesterase 5 (PDE5) and adenosine re-uptake. The most prominent side-effect is headache. We examined the migraine-generating effects of dipyridamole as well as the cerebral blood velocity response in a single-blind study, including 10 patients with migraine without aura and 10 healthy subjects. Dipyridamole 0.142 mg/kg per min was administered intravenously. Headache intensity was scored on a verbal rating scale along with pain characteristics and accompanying symptoms. Blood velocity in the middle cerebral artery (V(mca)), blood pressure and heart rate were recorded repeatedly. Headache was induced in all migraine patients and in eight of 10 healthy subjects (P = 0.47) with no significant difference in headache intensity (P = 0.53). However, five patients but only one healthy subject experienced the symptoms of migraine without aura, according to ICHD-2 criteria, within 12 h (P = 0.14). Four patients reported photophobia after dipyridamole compared with no healthy subjects (P = 0.087). V(mca) decreased (P < 0.001) during and after dipyridamole infusion with no difference between groups (P = 0.15) coinciding with initiation, but not cessation of immediate headache. Thus, dipyridamole induces symptoms of migraine and an initial decrease in V(mca) in migraine patients, but not significantly more than in healthy subjects. This relatively low frequency of migraine induction, compared with nitric oxide donors and sildenafil, is probably due to the less specific action of dipyridamole on the cGMP signalling pathway as well as a possible bidirectional effect of adenosine on migraine induction.
Collapse
Affiliation(s)
- C Kruuse
- Danish Headache Centre and Department of Neurology, University of Copenhagen, Glostrup Hospital, Denmark
| | | | | | | | | |
Collapse
|
20
|
Gamboa A, Abraham R, Diedrich A, Shibao C, Paranjape SY, Farley G, Biaggioni I. Role of adenosine and nitric oxide on the mechanisms of action of dipyridamole. Stroke 2005; 36:2170-5. [PMID: 16141426 DOI: 10.1161/01.str.0000179044.37760.9d] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The combination of dipyridamole and aspirin has been shown to be more effective than aspirin alone in the secondary prevention of stroke. Dipyridamole may act by inhibiting adenosine uptake, thus potentiating its actions. Dipyridamole also inhibits cGMP-specific phosphodiesterases (PDE) and, through this mechanism, could potentiate cGMP-mediated actions of nitric oxide. METHODS To define the mechanism of action of dipyridamole, we studied the local vascular effects of adenosine, acetylcholine (NO-mediated dilation), and nitroprusside (cGMP-mediated dilation) in a double-blind study after treatment with dipyridamole/aspirin (200 mg dipyridamole/25 mg aspirin twice a day) or aspirin control for 7 days in 6 normal volunteers. Vasodilators were administered into the brachial artery in the nondominant arm in random order and forearm blood flow (FBF) was measured by venous occlusion plethysmography. RESULTS Adenosine at a dosage of 125 mug/min increased FBF from 4.6+/-0.9 to 29.4+/-5.3 (539% increase) with dipyridamole/aspirin and from 3.9+/-0.8 to 12+/-2.5 mL/100 mL forearm/min (208% increase) with aspirin alone (P=0.007). In contrast, dipyridamole/aspirin did not alter the response to acetylcholine or to nitroprusside. The magnitude of adenosine-induced vasodilation correlated with plasma dipyridamole concentrations (r2=0.6); no correlation was observed with acetylcholine- or nitroprusside-induced vasodilation. Similar potentiation of adenosine, but not acetylcholine or nitroprusside, was observed in 7 additional subjects when adenosine, acetylcholine, and nitroprusside were given in random order before and 2 hours after a single dose of dipyridamole/aspirin. CONCLUSIONS The effects of dipyridamole on resistance vessels are preferentially explained by potentiation of adenosine mechanisms rather than potentiation of nitric oxide or other cGMP-mediated actions.
Collapse
Affiliation(s)
- Alfredo Gamboa
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | | | | | | | | | | |
Collapse
|