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        New Message Board Archives >> Medications, Treatments, Therapies 2004 >> Fresh Research - Nitrates and CH (2 articles)
        
(Message started by: floridian on Jan 20^th, 2004, 11:32am)

Title: Fresh Research - Nitrates and CH (2 articles)
Post by floridian on Jan 20^th, 2004, 11:32am

Two articles that focus on various nitrates, which are converted to nitric oxide, which causes blood vessels to expand and pinch nerves.

The first article claims that a nitroglycerin challenge is a fairly reliable test for cluster headache and migraine without aura, but not migraine with aura. 80% of clusterheads respond to nitroglycerin challenge with headaches. I am curious to know if the clusterheads were chronic or episodic, and if episodic if they were in a cycle or in remission.

In the second article, 8 clusterheads who were being treated for angina with long acting nitrate medicines had their headaches activated by the medicines. The medicines mentioned are long-acting organic nitrates (isosorbide-dinitrate, isosorbide-5-mononitrate or slow-release GTN). Add these to the list of triggers. Curiously, angina subsided when the clusterheads went into a headache cycle, indicating that elevated nitric oxide produced by the body may be protective for the heart even as it causes intense pain in the head.

Quote:

Cephalalgia. 2004 Feb; 24(2): 110-119.
Reliability of the nitroglycerin provocative test in the diagnosis of neurovascular headaches.

Sances G, Tassorelli C, Pucci E, Ghiotto N, Sandrini G & Nappi G. Reliability of the nitroglycerin provocative test in the diagnosis of neurovascular headaches. Cephalalgia 2004; 24:110-119. London. ISSN 0333-1024 Nitroglycerin administration provokes spontaneous-like migraine attacks in migraine and cluster headache (CH) patients. Nitroglycerin-induced migraine-like headache has been used as an experimental model of migraine. In this paper, we evaluate the possibility of using the nitroglycerin provocative test (NPT) as a supportive measure in the diagnosis of primary neurovascular headaches by assessing its reliability on a large population and adopting strict criteria for rating the response as positive or negative. Our population consisted of 197 migraineurs, 42 subjects suffering from cluster headache and 53 healthy controls. In migraine without aura, the test sensitivity was 82.1%, specificity 96.2% and accuracy 85.5%, while in subjects suffering from migraine with aura, the reliability of the NPT was less satisfactory (sensitivity 13.6%, specificity 96.2% and accuracy 72%). In CH patients tested during the active phase of the disease the sensitivity was 80.6%, specificity 100% and accuracy 92.9%. NPT is an easy, low-cost and reliable method for supporting the diagnosis of migraine without aura and cluster headache.

Quote:

Cephalalgia. 2004 Feb; 24(2): 92-98.
Periods of cluster headache induced by nitrate therapy and spontaneous remission of angina pectoris during active clusters.

Periods of cluster headache induced by nitrate therapy and spontaneous remission of angina pectoris during active clusters. Cephalalgia 2004; 24:92-98. London. ISSN 0333-1024 Glyceryl trinitrate (GTN) is known to induce single extra attacks of cluster headache (CH) during active cluster periods, most probably via actions of nitric oxide (NO). Induction of whole periods of CH by organic nitrates has, however, attracted little attention in the literature. We report on eight patients with episodic CH and coexistent effort-induced angina pectoris. Cases 1-6 had been free of their headaches for many years but got recurrence of CH within a few weeks after the administration of long-acting organic nitrates (isosorbide-dinitrate, isosorbide-5-mononitrate or slow-release GTN) aimed at treating their chest pains. These nitrate-induced headache periods were more severe and had a longer duration than the previous spontaneous ones. Furthermore, one of the subjects and two additional cases experienced a marked reduction of their anginal attacks during successive CH periods. Exercise time to effort-induced angina was increased in all three patients and one of them revealed a markedly elevated threshold for eliciting ischaemic cardiac symptoms by standardized physical exercise on a cycle ergometer. We hypothesize whether extra CH periods elicited by sustained nitrate therapy and remission of angina pectoris during active clusters are caused by central mechanisms involving inhibition of sympathetic tone and effects on both cranial vessels and cardiac functions.

Title: Re: Fresh Research - Nitrates and CH (2 articles)
Post by CJohnson on Jan 20^th, 2004, 12:04pm

Where are all of these clusterheads participating in these trials? Anybody here ever participate in a CH study or trial?
I always thought that nitro did not provoke an attack out of cycle.

That second abstract is a lot to think about. If I am not mistaken, it claims that the nitrate regimen actually triggered a cycle (not just a single attack) in "out of cycle" clusterheads. Whoa.

PFDANs
-Curtis

Title: Re: Fresh Research - Nitrates and CH (2 articles)
Post by CJohnson on Jan 20^th, 2004, 12:11pm

Verapamil is useful for treating angina.

PFDANs
-Curtis

Title: Re: Fresh Research - Nitrates and CH (2 articles)
Post by JDH on Jan 20^th, 2004, 1:10pm

on 01/20/04 at 12:04:22, CJohnson wrote:

Where are all of these clusterheads participating in these trials? Anybody here ever participate in a CH study or trial?

PFDANs
-Curtis

Curtis,
I took part in the Civamide study in late '02 and early '03. Found out about it right here.

Jim

Title: Re: Fresh Research - Nitrates and CH (2 articles)
Post by floridian on Jan 20^th, 2004, 2:40pm

I think one of the nitrate studies is from Italy, and the other from Sweden or Norway. That envelope with funny words that you threw away might have been an invite. [smiley=laugh.gif]

On the other hand, Europe has national healthcare systems, and it might be easier to identify and tap into the clusterhead population there than in the US - even with all the good work done here and at OUCH, the cluster community could be more fragmented in the US.

Anybody know what sort of disease registries there are in non-US countries?? Here's a study on the genetics of clusters that was done in Sweden by linking a registry of twins with a registry for hospitalization.

Quote:

A note on cluster headache in a population-based twin register
Da Svensson, K Ekbom1, NL Pedersen2,3, H Träff1 & E Waldenlind1

Evidence of a familial risk factor in cluster headache is accumulating and studies of twin concordance may resolve family resemblance into genetic and environmental influences. The past literature on cluster headache in twins comprises a few case reports of concordant monozygotic pairs. Swedish twin pairs with a diagnosis of cluster headache were selected through a cross-match of national registers of twin births and hospitalizations. Seventeen discordant twin pairs were found, in which it was possible to verify cluster headache status in 11 complete pairs (two monozygotic, four dizygotic, and five unlike-sexed pairs). In both members of a female monozygotic pair, migraine without aura developed after birth of the first child and remitted by menopause, whereas post-menopausal development of chronic cluster headache occurred in only one of them. The importance of individual specific factors for cluster headache was demonstrated. However, to explain familial aggregation a larger sample of affected twin pairs is necessary.

The logistics of doing a study are much better if you could easily identify 500 or so people within a few hours drive of the hospital or clinic doing the study. Some of the prospective subjects would be on vacation or medically ineligible for the study, others might not want to try a particular type of therapy. So they might get 50 or 100 from that 500 person list. If the rate of clusters is 1 per 1000, then a city of 1 million would have around 1000 cluster suferers. By contrast, one US metropolitan area of 1 million that I am familiar with has only 11 clusterheads listed at http://www.clusterheads.com/ That is about 1% of the expected number of cases for a million residents, and not enough to do a study - more intensive/expensive recruiting is needed.

Title: Re: Fresh Research - Nitrates and CH (2 articles)
Post by CJohnson on Jan 20^th, 2004, 3:47pm

Jim, how did you go about participating in the civamide trials? How did they go?

PFDANs
-Curtis

Title: Re: Fresh Research - Nitrates and CH (2 articles)
Post by ave on Jan 20^th, 2004, 3:50pm

Also, look at recent posts of Catlind, who was rushed to hospital with what they thought was heart problems.

She was given nitro and (I think) nearly scratched the hospital down havbing clusters.

Title: Re: Fresh Research - Nitrates and CH (2 articles)
Post by CJohnson on Jan 20^th, 2004, 3:52pm

Was she in a cycle?

PFDANs
-Curtis