Scopolamine-induced migraine like headache.
OBJECTIVE
Scopolamine butylbromide (SB), a muscarinic receptor antagonist, is used commonly in gastric X-ray examination in the physical check-up in Japan. This study describes clinical features of SB-induced headache.


METHODS
SB-induced headache was defined as headache that started within 20 minutes after intramuscular administration of SB (20 mg/body). The Primary and the secondary headaches were diagnosed according to the ICHD-II criteria. SB-induced headache was classified as headache induced by acute substance use or that due to exposure (ICHD-II code 8.1). Clinical features and background of subjects with SB-induced headache were analyzed. We also estimated the frequency of SB-related headache between migraineurs and non-migraineurs.


RESULTS
A total of 54 subjects (39 women and 15 men) experienced SB-induced headache. All subjects had the present history of migraine. Nine subjects had > or =2 times of the headache. Mean age (SD) was 46.2 (9.7) years [46.2 (9.7) for women and 46.3 (10.0) for men]. Clinical hallmarks of headache showed that pulsating / throbbing pain occurred in diffuse or bilateral head sites. Headache worsened at 20-30 minutes from the onset and persisted for 6-18 hours, and ameliorated gradually 8 hours later. All subjects had repeated nausea and vomiting. Severity of headache revealed severe degree requiring complete bed rest in 50 subjects (92.6%). SB-induced headache had similar characteristics as migraine without aura (MO) attacks. Liver and renal functions were normal in all SB-related migraineurs. They had no allergic history of medication and food. In 1,865 non-migraine controls, one healthy subject had a mild degree of migraine like headache triggered by SB injection.


CONCLUSIONS
SB triggers a severe degree MO like headache or worsens pre-existing migraine in some migraineurs. SB-induced headache could contribute to disequilibrium between acetylcholine and other neuropeptides. We should use SB more carefully as it can be an aggravating drug of migraine.
Department of Neurology, Toho University Omori Medical Center, Tokyo. keni@med.toho-u.ac.jp
Ken
K
Ikeda
Yuji
Y
Kawase
Takanori
T
Takazawa
Konosuke
K
Iwamoto
Hirono
H
Ito
Kiyoko
K
Murata
Ryuta
R
Sato
Tetsuro
T
Nagaoka
Tokinori
T
Sekine
Riya
R
Nagata
Yoshikazu
Y
Nakamura
Takehisa
T
Hirayama
Yuichi
Y
Ishikawa
Ken
K
Miura
Yasuhiro
Y
Yoshii
Yasuo
Y
Iwasaki
D000328:Adult; D005260:Female; D006261:Headache / Q000139:chemically induced* / Q000175:diagnosis*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000139:chemically induced* / Q000175:diagnosis*; D012601:Scopolamine / Q000008:administration & dosage / Q000009:adverse effects*
D012601:Scopolamine