title: Carbachol induces headache, but not migraine-like attacks, in patients with migraine without aura.
abstract: 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.
authors.affiliation: Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Danish Headache Center, Glostrup, Denmark. henrikschytz@dadlnet.dk
authors.forename: H W
authors.initials: HW
authors.lastname: Schytz
authors.forename: T
authors.initials: T
authors.lastname: Wienecke
authors.forename: J
authors.initials: J
authors.lastname: Olesen
authors.forename: M
authors.initials: M
authors.lastname: Ashina
mesh_terms: 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
chemical_list: D018679:Cholinergic Agonists; D009569:Nitric Oxide; D002217:Carbachol; D000109:Acetylcholine