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PubMed2006

Medications associated with probable medication overuse headache reported in a tertiary care headache center over a 15-year period.

OBJECTIVES: To evaluate the substances associated with medication overuse headache (MOH) in a headache center, over the course of the past 15 years. BACKGROUND: The acute treatment of migraine has substantially changed over the past 15 years, and therefore, the substances associated with MOH may have changed as well. METHODS: We randomly reviewed charts of subjects seen during the years of 2005, 2000, 1995, and 1990, to identify substances associated with MOH. Since the criteria proposed by the second edition of the International Classification of Headache Disorders require causal attribution, demonstrated by improvement after withdrawal (and this was not assessed in this study), herein we refer to probable MOH (PMOH). We contrasted the substances associated with PMOH over the studied years. RESULTS: Our sample consists of 1200 individuals, 300 per year of interest. The proportions of subjects with a diagnosis of PMOH remained stable over the years, varying from 64% of all cases seen in the center in 1990, to 59.3% in 2005. We found a significant decrease in the relative frequency of probable ergotamine overuse headache (from 18.6% to 0%, P < .0001), and in probable combination analgesic overuse headache (from 42.2% to 13.6%, P < .0001). The differences were not significant for opioid overuse headache. The relative frequency increased significantly for the triptans (from 0% to 21.6%, P < .0001), simple analgesics (from 8.8% to 31.8%, P < .05), and for combinations of acute medications (from 9.8% to 22.7%, P = .01). CONCLUSION: While overuse of acute medications remains an important problem in the tertiary care arena, the substances associated with the overuse have dramatically changed over the past 15 years. Educational initiatives should emphasize that the newer specific acute migraine medications (triptans) may also be associated with PMOH.

Adult↗
PubMed1976

Cerebral blood flow changes in cluster headache.

Serial cerebral blood flow studies performed by the intra-carotid 133Xenon method were fortuitously determined during the course of a cluster headache in a 32 year old man. The initial study was performed about 10 min after the headache began and showed values at the upper limit of normal. Twenty min after the headache started a second procedure showed that the autoregulatory response on hyperventilation was normal. Ergotamine tartrate was given intra-muscularly 23 min after the headache began and there was partial relief. A third cerebral blood flow estimation showed abnormally high values. The probable reasons for this are discussed.

Adult↗
PubMed1991

Anorectal ergotism. Induced by migraine therapy.

The current report describes 15 patients, 14 women and one man, in whom anorectal ulceration appeared after use of ergotamine suppositories. In seven cases there was only ulceration to be seen, whereas in eight anovaginal or rectovaginal fistulae were visible. Symptoms are not specific. In the majority of situations, ulceration can usually be treated successfully by immediate withdrawal alone. In one case a stenosis of the anal canal remained. Fistulae need surgical intervention. Two fistulae could be treated sufficiently by the local flap technique. In six cases a colostomy was needed, which was transient in five and permanent in one patient. One recurrence was seen after continued ergot-abuse. Dosage is not in direct correlation to ulceration.

Adult↗
PubMed1975

Tumor- and drug-induced cutaneous neuro-phospholipidosis.

Drugs and metastatic malignant tumors induce severe alterations in cutaneous axons. The most prominent ultrastructural feature of axonal dystrophy of this type was the presence of multiple lamellated osmiophilic bodies (LOB), similar to those occurring in hereditary disorders with increase of brain gangliosides and lipid storage. Chloroquine, ergotamine, ethaverine and chronic abuse of non-narcotic analgesic drugs seem to be responsible for the drug-induced cutaneous neuro-phospholipidosis, whereas the same condition was found in two patients with metastatic bronchogenic carcinoma and malignant melanoma.

Adult↗
PubMed1987

Structural and conformational analogy between cholecystokinin and ergopeptines.

The central nervous system (CNS) peptide cholecystokinin (CCK) and the ergopeptine alkaloids exhibit common pharmacology in the brain, particularly via catecholaminergic systems. We report here structural similarities between CCK and the ergot alkaloids, and the subsequent conformational analysis of the peptide undertaken to establish whether or not a three-dimensional relationship exists between the compounds. Two low-energy conformations of CCK that mimic the ergopeptine ergotamine are identified, one arising from an X-ray crystal structure and the other from a Dreiding model-based, computer-assisted search. The pharmacological, structural and conformational observations strongly support the hypothesis that CCK and the ergopeptines share common sites of action in the CNS.

Chemical Phenomena↗
PubMed1968

The effect of catecholamines on unit activity in afferent nerves from the adrenal glands.

1. Afferent discharges were observed in dissected filaments of nerves to the adrenal gland in the rabbit and cat.2. Systemic intravenous and close intra-arterial injections of (-)-adrenaline and (-)-noradrenaline caused cessation or depression of the spontaneous firing rate.3. Intravenous injection of acetylcholine and electrical stimulation of the splanchnic nerve also depressed the afferent discharge rate.4. Modification of blood pressure levels by chemical and mechanical means did not modify the afferent discharge.5. Alpha blocking agents (ergotamine and phenoxybenzamine) blocked the effect of (-)-adrenaline on the firing rate. Beta blocking agents (dichloroisoprenaline and propranolol) were without effect.6. It is suggested that an afferent system is present in the adrenal gland. Within this system are chemosensitive receptors which may constitute the afferent limb of a local feed-back loop involved in adrenal catecholamine release.

Acetylcholine↗
PubMed1969

Production of peptide ergot alkaloids in submerged culture by three isolates of Claviceps purpurea.

Three strains of Claviceps purpurea (Fr.) Tul., isolated from sclerotia grown on rye, produce under submerged conditions ergocryptine and ergotamine, ergocornine and ergosine, and ergocristine, respectively. All of the strains either lacked the ability to produce conidia or formed them sparingly, but they accumulated large quantities of lipids and sterols. The fermentations are typically divided into two phases. The first is characterized by the rapid utilization and exhaustion of the phosphate contained in the medium, rapid uptake of ammonium nitrogen and of citric acid, rapid growth, and low alkaloid production; the second phase is characterized by slower growth and by a marked accumulation of lipids, sterols, and alkaloids.

Ascomycota↗
PubMed1972

Footballer's migraine.

Classical migraine, including incapacitating visual field defects, repeatedly developed in five young men immediately after blows to the head while playing football and in no other circumstances. A similar condition occurred in a professional boxer and an isolated attack in a boy footballer. Prophylactic treatment with ergotamine tartrate may not be wholly successful and it may be necessary to give up the sport. Any unitary theory of causation of attacks of migraine must account for prodromal symptoms immediately after head injury.

Adult↗
PubMed1975

Migraine in general practitioners.

A self-administerd questionnaire was posted to 1 129 medical general practitioners in an urban and in a rural area of England. The prevalences of headache, and of the features of migraine, in the year immediately preceding the survey were similar in the two areas. After allowing for the different age and sex composition of the populations, these prevalences were also similar to those found in the general population during an early survey in Wales. About 13% of the male and 25% of the female general practitioners thought that they had had migraine in the previous year. There was little evidence that doctors with 'classic' migraine differed from those with 'common' migraine in the proportion who experienced other migrainous features (unilateral distribution of headache and accompanying nausea) or in their response to treatment with ergotamine.

Adult↗
PubMed1977

Sodium nitroprusside in the treatment of ergotism.

Severe peripheral vasoconstriction of the legs due to hypersensitivity to small doses of ergotamine tartrate developed in a patient with migraine headaches. The vasospasm was successfully treated with continuous intra-arterial and intravenous infusion of sodium nitroprusside. The contribution of angiography in the diagnosis and treatment of ergotism is stressed.

Adult↗
PubMed1991

A randomized, double-blind comparison of sumatriptan and Cafergot in the acute treatment of migraine. The Multinational Oral Sumatriptan and Cafergot Comparative Study Group.

The efficacy and safety of oral sumatriptan as a 100-mg dispersible tablet was compared with oral Cafergot (2 mg ergotamine tartrate, 200 mg caffeine) in a multicentre, randomized, double-blind, double-dummy, parallel-group trial. In the trial, 580 patients were treated from 47 investigating centres in nine European countries. Sumatriptan was significantly more effective than Cafergot at reducing the intensity of headache from severe or moderate to mild or none; 66% (145/220) of those treated with sumatriptan improved in this way by 2 h, compared with 48% (118/246) of those treated with Cafergot (p less than 0.001). The onset of headache resolution was more rapid with sumatriptan, whereas recurrence of migraine headache within 48 h was lower with Cafergot. Sumatriptan was also significantly more effective at reducing the incidence of nausea (p less than 0.001), vomiting (p less than 0.01) and photophobia/phonophobia (p less than 0.001) 2 h after treatment, and fewer patients on sumatriptan (24%) than on Cafergot (44%, p less than 0.001) required other medication after 2 h. The overall incidence of patients reporting adverse events was 45% after sumatriptan and 39% after Cafergot; the difference was not significant. The most commonly reported events in the sumatriptan-treated patients were malaise or fatigue and bad taste; these were generally mild and transient. Nausea and/or vomiting, abdominal discomfort, and dizziness or vertigo were reported by a greater proportion of Cafergot-treated patients. It is concluded that oral sumatriptan was well tolerated and is a more effective acute treatment for migraine than Cafergot.

Administration, Oral↗
PubMed1977

Effect of ergot alkaloids on sulfonylurea-stimulated insulin secretion in dogs.

The insulinogenic response to a standard i.v. dose of a sulfonylurea can be markedly augmented in normal, conscious dogs if they are given 30 min earlier a single i.v. dose of dihydroergotamine (DHE). Since the parent substance ergotamine posssed no such amplifying properties, further experiments were conducted to clarify the essential structural requirements that have to be fulfilled for an ergot alkaloid to act as an amplifier of sulfonylurea-stimulated insulin secretion. Amine alkaloids ergonovine, dihydroergonovone and dihydromethylergonovine had no amplifying potency, but the hydrogenated amino acid alkaloids dihydroergocornine, dihydroergocristine and dihydroergokryptine (Hydergine) were almost as potent amplifiers as was DHE. The data indicate that (a) DHE, Hydergine and by inference all hydrogenated amino acid alkaloids are potent amplifiers of sulfonylurea-stimulated insulin secretion; (b) saturation of the double bond at C9 and C10 of the lysergic acid moiety and the pressence of an amino acid side chain are essential structual requirements for an ergot alkaloid to function as an amplifier of the action of sulfonylureas; and (c) it appears that these compounds are acting chiefly by mechanisms other than alpha-adrenergic and serotonergic receptor blockade, perhaps as regulatory molecules inducing positive cooperative changes in integral proteins of the plasma membrane of beta cells.

Animals↗
PubMedDate not supplied

Transient aortic arch syndrome with dysphasia due to ergotism.

A 55-year-old woman with an aortic arch syndrome of acute onset and dysphasia, resulting from the excessive administration of ergotamine tartrate suppositories, is described. Complete resolution of symptoms and return of upper limb and carotid artery pulses to normal occurred within four days of cessation of the ergot derivative. Lower limb involvement was conspicuously absent in this case.

Angiography↗
PubMed1989

St. Anthony's fire: a medieval disease in modern times: case history.

Ergot intoxication is a syndrome recognized in the Middle Ages that was due to the effects of intense vasoconstriction upon the extremities. The authors present a patient with self-induced ergotamine poisoning who presented with vasospasm of the right lower extremity and had historical evidence suggestive of vasoconstriction involving other vascular systems. Excess ergot effect should be considered in the differential diagnosis of vascular insufficiency.

Drug Overdose↗
PubMed1995

A role for platelet-derived growth factor in drug-induced chronic ergotism? A case report.

Generalized vasoconstriction in chronic ergot poisoning is attributed both to the ergotamine activity on alpha-adrenergic receptors and to its direct action on vascular smooth muscle cells. The authors propose that endothelial wall, chronically damaged by ergot alkaloids, releases platelet-derived growth factor (PDGF), which contributes to vasoconstriction and promotes further arterial obstruction. Their hypothesis is supported by the increased PDGF activity found in plasma of a patient suffering from chronic ergotism.

Chronic Disease↗
PubMed1998

Successful treatment of ergotism with Iloprost--a case report.

A 34-year-old woman was hospitalized for severe acute arterial insufficiency of the limbs. Overuse of ergotamine derivative was acknowledged by the patient, who had a long history of migraine headaches. An arteriogram showed diffuse arterial spasm and occlusion of right leg distal arteries. Intravenous infusion of a stable prostacyclin analog (Iloprost) was administered. Rapid and complete improvement of arteriospasm was noted within a few hours, confirmed by a further arteriogram. This appears to be one of the rare case reports of successful limb salvage by use of Iloprost for ergotism.

Adult↗
PubMed1976

Failure to detect chromosome damage in bone-marrow cells of mice and Chinese hamsters exposed in vivo to some ergot derivatives.

A known chemical mutagen (Trenimon, Bayer), and three ergot derivatives (ergotamine tartrate, dihydroergotoxine mesylate, and methysergide hydrogen maleate) were tested in mice and Chinese hamsters for mutagenic effects by means of the micronucleus test and the conventional chromosome method. In contrast to Trenimon, which proved to be a powerful mutagen in these test systems, neither of the ergot derivatives showed an effect. It is concluded that these compounds, at subtoxic or therapeutic dose-levels, have no potential for damaging the chromosome complement of in vivo treated mammals.

Animals↗