Brain, Vol 120, Issue 2 283-288, Copyright © 1997 by Oxford University Press
M Fanciullacci, M Alessandri, R Sicuteri and S Marabini
Nitroglycerine is known to induce a headache attack in cluster headache
patients, which is indistinguishable from a spontaneous attack. It has
recently been suggested that a release of calcitonin gene-related peptide
(CGRP) from peripheral terminals of trigeminal nociceptive neurons, which
supply cephalic blood vessels, underlies symptoms of cluster headache. The
aim of this study was to investigate whether the provocative action of
nitroglycerine in cluster headache is due, at least in part, to activation
of the trigeminovascular system. Nineteen subjects suffering from episodic
cluster headache participated in the study. Eleven of them were in an
active period, whilst the others were in remission at the time of the
study. CGRP-like immunoreactivity (CGRP- LI) was measured in blood samples
from the extracerebral circulation before and after the sublingual
administration of nitroglycerine. Baseline CGRP-LI plasma levels were
higher (P < 0.05) in the patients who were in an active period. Only in
these patients did nitroglycerine induce an attack, which was preceded by a
latent period with a mean duration of 27 +/- 3 min. When compared with the
baseline, a significant (P < 0.01) increase in plasma CGRP-LI was
detected at the peak of the provoked attack; no such increase was detected
during the latent period, or at the onset of the attack. The results of
this study suggests that the provocative action of nitroglycerine in
cluster headache is due, at least in part, to activation of the
trigeminovascular system. This mechanism seems to be slow and unrelated to
the well-known rapidly occurring vasodilator effects of the drug. Finally,
activation of the trigeminovascular system only occurs in those patients
already in an active cluster headache period who also have high basal
CGRP-LI plasma levels. This suggests that a hyperactivity of trigeminal
nociceptive fibres could make the trigeminovascular system of these
patients sensitive to the triggering action of nitroglycerine.
ARTICLES
Responsiveness of the trigeminovascular system to nitroglycerine in cluster headache patients
Institute of Internal Medicine and Therapeutics IV, Headache Centre, University of Florence, Italy.
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