scholarly journals Maladaptive activation of Nav1.9 channels by nitric oxide causes triptan-induced medication overuse headache

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Caroline Bonnet ◽  
Jizhe Hao ◽  
Nancy Osorio ◽  
Anne Donnet ◽  
Virginie Penalba ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Signal Analysis ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Signaling Networks ◽  
Over The Counter ◽  
Chronic Medication ◽  
Trigeminal Neurons ◽  
Combination Analgesics ◽  
Pain Signal

Abstract Medication-overuse headaches (MOH) occur with both over-the-counter and pain-relief medicines, including paracetamol, opioids and combination analgesics. The mechanisms that lead to MOH are still uncertain. Here, we show that abnormal activation of Nav1.9 channels by Nitric Oxide (NO) is responsible for MOH induced by triptan migraine medicine. Deletion of the Scn11a gene in MOH mice abrogates NO-mediated symptoms, including cephalic and extracephalic allodynia, photophobia and phonophobia. NO strongly activates Nav1.9 in dural afferent neurons from MOH but not normal mice. Abnormal activation of Nav1.9 triggers CGRP secretion, causing artery dilatation and degranulation of mast cells. In turn, released mast cell mediators potentiates Nav1.9 in meningeal nociceptors, exacerbating inflammation and pain signal. Analysis of signaling networks indicates that PKA is downregulated in trigeminal neurons from MOH mice, relieving its inhibitory action on NO-Nav1.9 coupling. Thus, anomalous activation of Nav1.9 channels by NO, as a result of chronic medication, promotes MOH.

Medication-overuse headache in China: Clinical profile, and an evaluation of the ICHD-3 beta diagnostic criteria

Cephalalgia ◽  
2014 ◽  
Vol 35 (8) ◽  
pp. 644-651 ◽  
Author(s):  
Zhao Dong ◽  
Xiaoyan Chen ◽  
Timothy J Steiner ◽  
Lei Hou ◽  
Hai Di ◽  
...  
Keyword(s):  
Secondary School ◽  
Diagnostic Criteria ◽  
Educational Level ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Demographic Data ◽  
Clinical Profile ◽  
Time To Diagnosis ◽  
Combination Analgesics ◽  
Chinese Yuan

Background Although medication-overuse headache (MOH) is common in China, its clinical profile is not yet fully established. Meanwhile, ICHD-3 beta has been published, but its diagnostic criteria require further validation. Methods We retrospectively classified the clinical features of 240 consecutive patients with MOH (55 males, 185 females), whose demographic data, headache features, overused medications (type, quantity, frequency and duration of use), headache-attributed burden, and outcomes were reviewed. We then applied the criteria of the several versions of ICHD (II, IIR and 3-beta) to these patients. Results Compared with those with other headaches, patients with MOH were more likely to be less well educated (64.6% vs 42.0% for secondary school or lower, p < 0.0001), and on lower annual incomes (72.3% vs 56.0% for an income of Chinese yuan (CNY) 30,000 or less, p < 0.0001). Combination analgesics were the most commonly overused medications, and, caffeine (89.9%), aminopyrine (70.0%), phenacetin (53.9%) and phenobarbital (48.8%) were the most commonly used specific components of these. Only two patients (0.8%) had previously been given the diagnosis of MOH; accordingly, the median time to diagnosis after the estimated onset of the disorder was 4.0 years. The majority of patients (83.7%) improved with treatment. All 240 patients fulfilled the diagnostic criteria for MOH according to ICHD-3 beta; only 134 (55.8%) satisfied the diagnostic criteria for definite MOH according to ICHD-II, while 195 (81.2%) met those of ICHD-IIR. Conclusions MOH in China is associated with lower educational level and annual income. MOH has rarely been diagnosed and correctly treated in China. ICHD-3 beta appears to be more appropriate for the diagnosis of MOH than previous versions.

scholarly journals Author Correction: Maladaptive activation of Nav1.9 channels by nitric oxide causes triptan-induced medication overuse headache

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Caroline Bonnet ◽  
Jizhe Hao ◽  
Nancy Osorio ◽  
Anne Donnet ◽  
Virginie Penalba ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Medication Overuse ◽  
Medication Overuse Headache

Headaches

2019 ◽  
pp. 21-46
Author(s):  
David L. Brody
Keyword(s):  
Hypothesis Testing ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Atypical Presentation ◽  
Over The Counter ◽  
Specific Hypothesis ◽  
Careful History

First Rule: Triage is more important than diagnosis. Take a careful history by asking specific hypothesis-testing questions. Examine the patient. This is important. You can’t do it over the phone. Second rule: Migraines are really common after concussion; an atypical presentation of migraine is still more likely than most other types of headaches. Consider nonpharmacological measures, triptans, over-the-counter analgesics, and good prophylaxis as for regular migraine. Third rule: Patients can have more than one type of headache at the same time. Fourth Rule: Patients with medication overuse headache aren’t going to get better from anything you do until the medication overuse is addressed. Consider admitting patients with medication overuse headaches to the hospital.

Headaches

2014 ◽  
pp. 15-30
Author(s):  
David L Brody
Keyword(s):  
Hypothesis Testing ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Atypical Presentation ◽  
Over The Counter ◽  
Specific Hypothesis ◽  
Careful History

This chapter presents four rules for treating concussion headache: (1) Triage is more important than diagnosis. Take a careful history by asking specific hypothesis testing questions. Examine the patient. This is important. You can’t do it over the phone. (2) Migraines are really common after concussion; an atypical presentation of migraine is still more likely than most other types of headaches. Consider nonpharmacological measures, triptans, over the counter analgesics, and good prophylaxis as for regular migraine. (3) Patients can have more than one type of headache at the same time. (4) Patients with medication overuse headache aren’t going to get better from anything you do until the medication overuse is addressed. Consider admitting patients with medication overuse headaches to the hospital.

scholarly journals Nasal decongestant and chronic headache: a case of naphazoline overuse headache?

F1000Research ◽  
2013 ◽  
Vol 2 ◽  
pp. 237 ◽  
Author(s):  
Cherubino Di Lorenzo ◽  
Gianluca Coppola ◽  
Valeria La Salvia ◽  
Francesco Pierelli
Keyword(s):  
Nitric Oxide ◽  
Chronic Headache ◽  
Chronic Sinusitis ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Inflammatory Cascade ◽  
Nasal Decongestant ◽  
Nasal Decongestants ◽  
Icd 10 ◽  
Chronic Headaches

Background: Chronic headache is an incapacitating condition afflicting patients at least for 15 days per month. In the most cases it is developed as a consequence of an excessive use of symptomatic drugs.Case: Here we report the case of a 34 year-old man suffering from chronic headache possibly related to the overuse of naphazoline nitrate nasal decongestant, used to treat a supposed chronic sinusitis. However, the patient did not suffer from sinusitis, but from a medication overuse headache (ICHD-II 8.3; ICD-10 44.41) that appeared to be due to excessive use of naphazoline.Conclusion: The use of naphazoline nitrate may result in an analgesic effect upon first use, through activation of adrenergic and opioidergic systems, followed by a pro-migraine effect via a late induction of an inflammatory cascade, modulated by nitric oxide and arachidonic acid. The observation that naphazoline detoxification relieved the patient’s headache, indicates that prolonged use of naphazoline may cause chronic headaches. Therefore, physicians should ask for details on the use of nasal decongestants in patients complaining of chronic headache, as they could potentially be suffering from a medication-overuse headache.

Clinical Features of Probable Medication-Overuse Headache: A Retrospective Study in Japan

Cephalalgia ◽  
2007 ◽  
Vol 27 (9) ◽  
pp. 1020-1023 ◽  
Author(s):  
N Imai ◽  
E Kitamura ◽  
T Konishi ◽  
Y Suzuki ◽  
M Serizawa ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Chronic Migraine ◽  
Clinical Picture ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Primary Headache ◽  
Tension Type Headache ◽  
Headache Type ◽  
Combination Analgesics ◽  
Type Headache

This study examined the clinical picture of probable medication-overuse headache (MOH) and the presence of any features peculiar to Japan. In a retrospective study of 47 patients, type of primary headache, type of medicine overused, method and result of withdrawal were investigated. Among the 47 patients, 80.9% had migraine only, and 85.1% overused combination medications. While 36 patients (76.6%) succeeded in withdrawal, five patients (10.6%) failed. One patient (2.1%) had not improved by 2 months after withdrawal and was diagnosed with chronic migraine and chronic tension-type headache without MOH. The remaining five patients (10.6%) dropped out. All dropout patients were recommended abrupt inpatient withdrawal, but chose abrupt outpatient withdrawal. As features peculiar to Japan, many patients with probable MOH overused combination analgesics, particularly females.

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