Nitroglycerin can cause migraines and abnormal cardiovascular reactions. Free Technical Library News

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Nitroglycerin May Cause Migraines and Abnormal Cardiovascular Reactions

18.12.2019

In addition to the recognized migraine-provoking effects of nitroglycerin, a study reports abnormal cardiovascular regulation of this compound in patients with migraine.

Nitroglycerin is a potent vasodilator and is known to cause migraine attacks in migraine patients. Due to its vasodilating properties, nitroglycerin is used in cardiovascular studies to test for cardiovascular changes in blood pressure measurements secondary to venous pooling. For example, nitroglycerin is used to test baroreflex function in individuals with vasovagal syncope, which is common in migraine patients.

Scientists at the Leiden University Medical Center assessed cardiovascular parameters using photoplethysmography (blood pressure, heart rate, stroke volume, cardiac output, peripheral resistance) before (-10 min), during intravenous nitroglycerin administration (20 min) and after nitroglycerin administration (10 min.) They compared the differences between migraine patients who had nitroglycerin-induced attacks and healthy controls. The presence of vasovagal syncope was also taken into account.

Ten healthy participants and 16 patients with migraine were included in the study. Thirteen of 16 patients (81,3%) had migraine attacks after nitroglycerin infusion, versus none in the control group. Vasovagal syncope was not provoked. Patients with migraine showed a higher heart rate in response to nitroglycerin infusion. In a subgroup analysis of patients with migraine divided into patients with early attacks (those who had attacks <270 minutes after NTG infusion) or late attacks (at >270 minutes), stroke volume and cardiac output were reduced in both cases within migraine group compared to the healthy control group, with a more pronounced reduction in the early-onset migraine group.

The authors interpret these data with caution as the study was underpowered with a small sample size. Dr. van Oosterhout said, "The increased systemic circulatory response to nitroglycerin in migraine suggests that the systemic vasculature is more susceptible to its (vasodilating) effects." And adds: "Sensitivity to nitric oxide (NO) may be increased, possibly due to higher perivascular concentrations of NO synthase." Finally, although none of the participants had vasovagal syncope, the authors do not rule out a common susceptibility to migraine attacks and vasovagal syncope, as some patients in this study also experienced vasovagal syncope in life.

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