Prostaglandin E(2) induces immediate migraine-like attack in migraine patients without aura.
BACKGROUND
Prostaglandin E(2) (PGE(2)) has been suggested to play an important role in the pathogenesis of migraine. In the present experiment we investigated if an intravenous infusion of PGE(2) would induce migraine-like attacks in patients with migraine.


METHODS
Twelve patients with migraine without aura were randomly allocated to receive 0.4 µg/kg/min PGE(2) (Prostin(®)E2, dinoprostone) or placebo over 25 minutes in a two-way, crossover study. Headache intensity was recorded on a verbal rating scale, middle cerebral artery blood flow velocity (V(MCA)) was measured by transcranial Doppler (TCD) and diameter of the superficial temporal artery (STA) was obtained by c-series scan (Dermascan C).


RESULTS
In total, nine migraine patients (75%) experienced migraine-like attacks after PGE(2) compared to none after placebo (p = 0.004). Seven out of 9 (58%) patients reported the migraine-like attacks during the immediate phase (0-90 min) (p = 0.016). Only two patients experienced the delayed migraine-like attacks several hours after the PGE(2) infusion stop (p = 0.500). The V(MCA) decreased during the PGE(2) infusion (p = 0.005) but there was no significant dilatation of the STA (p = 0.850).


CONCLUSIONS
The migraine-like attacks during, and immediately after, the PGE(2) infusion contrast with those found in previous provocation studies, in which the other pharmacological compounds triggered the delayed migraine-like attacks several hours after the infusion. We suggest that PGE(2) may be one of the important final products involved in the generation of migraine attacks.
Danish Headache Center and Department of Neurology, University of Copenhagen, Denmark.
Maria
M
Antonova
Troels
T
Wienecke
Jes
J
Olesen
Messoud
M
Ashina
D000293:Adolescent; D000328:Adult; D018592:Cross-Over Studies; D015232:Dinoprostone / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D020325:Migraine with Aura / Q000139:chemically induced* / Q000503:physiopathology*; D020326:Migraine without Aura / Q000503:physiopathology*; D055815:Young Adult
D015232:Dinoprostone