Chronic paroxysmal hemicrania and hemicrania continua. Parenteral indomethacin: the 'indotest'.
Journal - Headache (UNITED STATES )
The interval between indomethacin administration and clinical response may be clinically relevant in the assessment of chronic paroxysmal hemicrania and hemicrania continua and other unilateral headache disorders with which they can be confounded. Eight patients with chronic paroxysmal hemicrania (6 women and 2 men) and 12 patients with hemicrania continua (8 women and 4 men) were entered into the study. The patients were given 50 mg of indomethacin intramuscularly (i.m.) on day 1 and some of them 100 mg IM on day 2 in an open fashion. The usual attack pattern was reestablished prior to the second test. The mean interval between attacks before the two injections (51 +/- 18 minutes) in chronic paroxysmal hemicrania was significantly shorter than the mean after each of the two indomethacin injections (50 mg = 493 +/- 251 minutes; 100 mg = 668 +/- 211 minutes; P < 0.001; Mann-Whitney test). In every patient, there was a clear refractory period after indomethacin. Since the first "expected" attack after indomethacin administration did not occur, it can, with reasonable certainty, be assumed that the protective phase was initiated already prior to the time of the next "anticipated" attack. The mean attack duration was 22 minutes (last three attacks prior to test). The mean interval between the onset of two consecutive pretest attacks was 73 minutes. Since the interval between attacks was rather stable, one is, therefore, probably allowed to assume that the absolute protective effect of indomethacin on average had begun somewhere between 22 (mean attack duration) and 73 minutes after indomethacin injection. Similarly, in hemicrania continua, the time between 50-mg indomethacin injection and complete pain relief was 73 +/- 66 minutes. The pain-free period after indomethacin injection was around 13 hours (i.e., 13 +/- 8 hours after 50 mg and 13 +/- 10 hours after 100 mg). The use of a test dosage of 50 mg of indomethacin IM ('indotest') gives a clear-cut answer and may be a useful tool in the diagnostic arsenal in every unilateral headache for a proper clinical assessment. A diagnosis of chronic paroxysmal hemicrania or hemicrania continua is a serious matter because it may imply life-long treatment with a potentially noxious drug. It is, therefore, of the utmost importance that an 'indotest' is carried out in a standard fashion. In the future, the rules set forth in the present context should be followed, at least in scientific studies. Pain pressure thresholds at cranial and extracranial levels were not significantly modified after indomethacin injection in any of the headaches.
|ISSN : ||0017-8748|
|Mesh Heading : ||Adult Aged Anti-Inflammatory Agents, Non-Steroidal Chronic Disease Dose-Response Relationship, Drug Female Headache Humans Indomethacin Injections Male Middle Aged Pain Measurement Pain Threshold Recurrence Time Factors pharmacology physiopathology pharmacology drug effects|
|Mesh Heading Relevant : ||administration & dosage diagnostic use diagnosis drug therapy administration & dosage diagnostic use|
Epileptic seizure during aspirin and caffeine withdrawal in a drug induced headache.
Journal - Functional neurology (ITALY )
A 45-year-old female migraineur with a long-standing history of drug-induced headache is described. She had been abusing caffeine (250 mg/day) and aspirin (5 gr/day). On the third day after discontinuation a withdrawal syndrome characterized by headache and a generalized tonic-clonic seizure occurred. The temporal association makes it likely that the convulsion episode in an integral component of the withdrawal syndrome in this patient. This extra feature of the withdrawal syndrome has never been described after caffeine and/or aspirin interruption. Possible pathogenetic mechanisms are discussed.
|ISSN : ||0393-5264|
|Mesh Heading : ||Anti-Inflammatory Agents, Non-Steroidal Aspirin Caffeine Central Nervous System Stimulants Drug Combinations Epilepsy, Tonic-Clonic Female Headache Humans Middle Aged Migraine Disorders Substance Withdrawal Syndrome etiology chemically induced complications|
|Mesh Heading Relevant : ||adverse effects adverse effects adverse effects adverse effects physiopathology complications physiopathology|