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Prostaglandin E2 induces immediate migraine-like attack in migraine patients without aura

Background

Prostaglandin E2 (PGE2) has been suggested to play an important role in the pathogenesis of migraine [1]. In the present experiment we investigated if an intravenous infusion of PGE2 would induce migraine-like attacks in patients with migraine.

Methods

Twelve patients with migraine without aura were randomly allocated to receive 0.4 ìg/kg/min PGE2 (Prostin®E2, dinoprostone) or placebo over 25 min in a two-way, cross-over study. Headache intensity was recorded on a verbal rating scale, middle cerebral artery blood flow velocity (VMCA) was measured by Transcranial Doppler (TCD) and diameter of superficial temporal artery (STA) was obtained by c-series scan (Dermascan C).

Results

In total 9 migraine patients (75%) experienced migraine-like attacks after PGE2 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 PGE2 infusion stop (P = 0.500). The VMCA decreased during the PGE2 infusion (P = 0.005) but there was no significant dilatation of the STA (P = 0.850).

Conclusion

The migraine-like attacks during, and immediately after, the PGE2 infusion contrast with those found in the previous provocation studies, where the other pharmacological compounds triggered the delayed migraine-like attacks several hours after the infusion. We suggest that PGE2 may be one of the important final products involved in the generation of migraine attacks.

References

  1. Wienecke T, Olesen J, Oturai PS, et al.: Prostaglandin E2(PGE2) induces headache in healthy subjects. Cephalalgia 2009, 29: 509–519. 10.1111/j.1468-2982.2008.01748.x

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Open Access This article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Antonova, M., Wienecke, T., Olesen, J. et al. Prostaglandin E2 induces immediate migraine-like attack in migraine patients without aura. J Headache Pain 14, P113 (2013). https://doi.org/10.1186/1129-2377-14-S1-P113

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  • DOI: https://doi.org/10.1186/1129-2377-14-S1-P113

Keywords

  • Migraine
  • PGE2
  • Migraine Attack
  • Blood Flow Velocity
  • Migraine Patient