Prolonged Migraine Aura Without Headache Arrested by Sumatriptan. A Case Report with Further Considerations

The case of a 42-year-old woman with prolonged migraine visual aura without headache, whose long-lasting episodes of visual aura were successfully controlled by oral sumatriptan, is reported. Effectiveness of sumatriptan was unequivocal, since, after taking sumatriptan, duration of aura would drop from 1.5 h to approximately 20 min. This case suggests that sumatriptan may cross the blood-brain barrier and block spreading depression.

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Fremanezumab and its isotype slow propagation rate and shorten cortical recovery period but do not prevent occurrence of cortical spreading depression in rats with compromised blood–brain barrier

Pain ◽

10.1097/j.pain.0000000000001791 ◽

2020 ◽

Vol 161 (5) ◽

pp. 1037-1043 ◽

Cited By ~ 2

Author(s):

Agustin Melo-Carrillo ◽

Aaron J. Schain ◽

Jennifer Stratton ◽

Andrew M. Strassman ◽

Rami Burstein

Keyword(s):

Blood Brain Barrier ◽

Cortical Spreading Depression ◽

Spreading Depression ◽

Recovery Period ◽

Propagation Rate ◽

Brain Barrier ◽

Blood Brain ◽

Slow Propagation

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Recurrent spreading depression (SD) causes early opening of the blood-brain barrier (BBB)

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/sj.jcbfm.9591524.0260 ◽

2005 ◽

Vol 25 (1_suppl) ◽

pp. S260-S260 ◽

Cited By ~ 1

Author(s):

Sebastian Major ◽

Alon Friedman ◽

Jens P Dreier

Keyword(s):

Blood Brain Barrier ◽

Spreading Depression ◽

Brain Barrier ◽

Blood Brain

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Exploring the effects of extracranial injections of botulinum toxin type A on prolonged intracranial meningeal nociceptors responses to cortical spreading depression in female rats

Cephalalgia ◽

10.1177/0333102419873675 ◽

2019 ◽

Vol 39 (11) ◽

pp. 1358-1365 ◽

Cited By ~ 7

Author(s):

Agustin Melo-Carrillo ◽

Andrew M Strassman ◽

Aaron J Schain ◽

Rodrigo Noseda ◽

Sait Ashina ◽

...

Keyword(s):

Blood Brain Barrier ◽

Cortical Spreading Depression ◽

Botulinum Neurotoxin ◽

Spreading Depression ◽

Type A ◽

Female Rats ◽

Brain Barrier ◽

Male Rats ◽

Botulinum Neurotoxin Type A ◽

Blood Brain

Background Botulinum neurotoxin type A, an FDA-approved prophylactic drug for chronic migraine, is thought to achieve its therapeutic effect through blocking activation of unmyelinated meningeal nociceptors and their downstream communications with myelinated nociceptors and potentially the vasculature and immune cells. Prior investigations to determine botulinum neurotoxin type A effects on meningeal nociceptors were carried out in male rats and tested with stimuli that act outside the blood brain barrier. Here, we sought to explore the effects of extracranial injections of botulinum neurotoxin type A on activation of meningeal nociceptors by cortical spreading depression, an event which occurs inside the blood brain barrier, in female rats. Material and methods Using single-unit recording, we studied myelinated C- and unmyelinated Aδ-meningeal nociceptors' responses to cortical spreading depression 7–14 days after injection of botulinum neurotoxin type A or saline along calvarial sutures. Results In female rats, responses to cortical spreading depression were typically more prolonged and, in some cases, began at relatively longer latencies post-cortical spreading depression, than had been observed in previous studies in male rats. Extracranial administration of botulinum neurotoxin type A reduced significantly the prolonged firing of the meningeal nociceptors, in the combined sample of Aδ- and C-fiber, but not their response probability. Discussion The findings suggest that the mechanism of action by which botulinum neurotoxin type A prevents migraine differ from the one by which calcitonin gene-related peptide monoclonal antibodies prevent migraine and that even when the origin of migraine is central (i.e. in the cortex), a peripherally acting drug can intercept/prevent the headache.

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