Carbachol induces headache, but not migraine-like attacks, in patients with migraine without aura.
Carbachol induces headache in healthy subjects, but the migraine eliciting effect of carbachol has not previously been studied. We hypothesized that the cholinomimetic agonist carbachol would induce headache and migraine-like attacks in migraineurs. Carbachol (3 µg/kg) or placebo was randomly infused into 18 patients with migraine without aura in a double-blind crossover study. Headache was scored on a verbal rating scale from 0 to 10. Velocity in the middle cerebral artery (V(MCA)) and diameter of the superficial temporal artery (STA) were recorded. Fifteen patients experienced headache after carbachol compared with eight after placebo (P = 0.039). There was no difference in incidence of migraine-like attacks after carbachol (n = 8) compared with placebo (n = 6) (P = 0.687). Carbachol caused a decrease in V(MCA) (P = 0.044), but no change in STA (P = 0.089) compared with placebo. The study demonstrated that carbachol provocation is not a good model for experimental migraine.
Schytz
H W
HW
Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Danish Headache Center, Glostrup, Denmark. henrikschytz@dadlnet.dk
Wienecke
T
T
Olesen
J
J
Ashina
M
M
D000109:Acetylcholine / Q000378:metabolism; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D002217:Carbachol / Q000008:administration & dosage / Q000009:adverse effects*; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology; D018679:Cholinergic Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D018592:Cross-Over Studies; D005260:Female; D006261:Headache / Q000139:chemically induced*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D020768:Middle Cerebral Artery / Q000187:drug effects / Q000502:physiology; D020326:Migraine without Aura / Q000139:chemically induced*; D009569:Nitric Oxide / Q000378:metabolism; D055815:Young Adult
D018679:Cholinergic Agonists; D009569:Nitric Oxide; D002217:Carbachol; D000109:Acetylcholine