[Latency and evidence of pathology in migraine: clinico-pharmacological and therapeutic considerations on a drug antagonist of serotonin and histamine].
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Biomedical subjects
Publications and source records attributed to B Anselmi.
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A short-lasting overdistension of the hand-forearm veins, through the application of the Hand Arm Vein Distension (HAVD) test was carried out on patients suffering from migraine (no. = 102) and females with chronic daily headache (no. = 26): chronic tension-type headache (CTH) and migraine with interparoxysmal headache (MIH). Comparisons were made with a group of healthy controls (no. = 20). The HAVD test induced pain more often in female (65%) than in male migraineurs (14%) and female controls (p < 0.01). No significant difference appeared between male migraineurs and male controls. No significant difference was evidenced between female migraineurs in headache and headache-free periods. Patients with CTH showed less sensitivity to HAVD than those with MIH and migraine (respectively p < 0.01 and p < 0.05) and even a longer latency before the onset of pain. The findings show a stronger extracephalic pain sensitivity in migraineurs than in healthy controls, but sex must be taken into account. The results suggest that pain sensitivity is not correlated with the presence of headache.
Several reports indicate higher endothelin-1 (ET-1) levels in patients with non insulin dependent diabetes mellitus (NIDDM), although this finding has not been confirmed by other studies. The discrepancy may be partially explained by the frequent coexistence in NIDDM patients of other pathologies, such as essential hypertension, and by the presence of diabetic vascular complications or renal failure, able, per se, to increase ET-1 circulating levels. This study aimed to evaluate the influence of arterial hypertension and/or of diabetic angiopathy on ET-1 circulating levels in a group of NIDDM patients. We measured ET-1 plasma concentrations in three groups of subjects: a) 22 NIDDM patients with or without hypertension and with or without vascular complications; b) 11 hypertensive patients; c) 14 age-matched healthy volunteers. Plasma ET-1 concentrations were significantly higher in NIDDM patients with angiopathy (7.3 +/- 0.7 pg/ml, mean +/- Standard Error; p < 0.001) than diabetics without angiopathy (4.4 +/- 0.53 pg/ml), hypertensive patients (4.7 +/- 0.85 pg/ml) and healthy subjects (3.1 +/- 0.19 pg/ml). This report indicates that increased plasma ET-1 levels in NIDDM patients may be ascribed only to those with vascular compliances, while hypertension, per se, does not affect ET-1 plasma levels in these patients.
Histamine is able to induce spontaneous-like headache attacks in migraine and cluster headache subjects. Therefore, it has been considered as a possible agent in the pathogenesis of headache. Histamine desensitization is used for the treatment of cluster and other chronic headaches like migrains with interparoxysmal headache. However, it is unknown whether desensitization plays a role in headache improvement. Since a disfunction of the opioid system has been considered responsible for idiopathic headache and since low beta-endorphin levels have been demonstrated in some idiopathic headaches, particularly in migraine with interparoxysmal headache, we planned this study to verify if histamine therapy is able to modify serum beta-endorphin concentrations. For this purpose, we studied 24 healthy control subjects and 36 patients suffering from migraine with interparoxysmal headache refractory to conventional therapies. Patients showed baseline serum beta-endorphin levels significantly lower than healthy control subjects and treatment with histamine for 15 days increased their beta-endorphin concentrations. We believe that histamine treatment can activate the opioid endogenous system. However, the therapeutic effect of histamine remains to be verified by evaluating the correlation between beta-endorphin levels and headache improvement.