Migraine Attack in Response to Nitroglycerin Showed Greater Cardiovascular Responses, Study Finds

A study investigating the cardiovascular responses to nitroglycerin in migraine found that migraineurs who developed a migraine-like attack in response to nitroglycerin demonstrated greater systemic cardiovascular responses compared with non-headache controls.

The research, published by Cephalalgia, involved 16 women with migraine and without aura to 10 age- and gender-matched controls without headache. Intravenous nitroglycerin was administered in all patients and finger photoplethysmography was used to evaluate the cardiovascular parameters before, during, and after nitroglycerin infusion.

“Some studies have suggested ictal and interictal functional changes in the systemic circulation in migraine. Interestingly, migraineurs also have an increased rate of vasovagal syncope (VVS), which partly explains the white matter abnormalities found in a population-based study,” noted the authors. “Nitroglycerin may also provoke migraine attacks, but only in migraineurs. Nitroglycerin is de-nitrated to nitric oxide (NO) and vasoactive S-nitrosothiols. Both substances cause vasodilation through activation of cytoplasmic guanylate cyclase, which increases intracellular guanosine-3’,5’-monophosphate (cGMP) and cytosolic calcium.”

The analysis revealed that nitroglycerin provoked a migraine-like attack in 81.2% of migrainers but not in the controls. In addition, migraineurs who later developed a migraine-like attack showed different responses in all parameters compared to the controls, including: decreases in cardiac output and stroke volume were more rapid and longer lasting, heart rate increased, and the average arterial pressure and total peripheral resistance were higher and decreased steeply after the initial increase, according to the results.

“Using continuous photoplethysmography, we showed that intravenous nitroglycerin administration induced a faster and more prolonged decrease in stroke volume and cardiac output, a steep decrease in total peripheral resistance after an initial increase, a slightly higher mean arterial pressure, and a sustained increase in heart rate in migraine participants in whom an attack developed later,” explained the authors. “The enhanced response of the systemic circulation to nitroglycerin in migraineurs suggest that the systemic vasculature is more susceptible to its (vasodilatory) effects.”

The researchers concluded that the stronger systemic cardiovascular responses in migraine suggested increased systemic sensitivity to vasodilators which may be due to insufficient autonomic compensatory mechanisms. Further studies may be needed to investigate the differences between attack-onset subgroups, according to the authors.

Reference

Van Oosterhout W, Schoonman G, et al. Abnormal cardiovascular response to nitroglycerin in migraine [published online October 9, 2019]. Cephalalgia. doi: 10.1177/0333102419881657.