Kampo extract goshuyuto for prevention of paroxysmal atrial fibrillation associated with migraine attack

Abstract

Case: Not only non-steroidal anti-inflammatory drugs (NSAIDs) but also triptans, called a 'magic bullet' against migraine attacks, increase the incidence of atrial fibrillation (AF). Additionally, the migraine attack itself may induce AF. A 66-year-old man visited hospital, complaining of palpitation after taking NSAIDs containing acetaminophen, ethenzamide and caffeine for a migraine attack. When pilsicainide hydrochloride hydrate was given, the AF was restored to sinus rhythm in 2 h. Outcome: Goshuyuto, a kampo formula used for headache, consists of four constituent drugs: Zizyphus fructus, Evodia fructus, Ginseng radix and Zingiber rhizome; these four crude drugs may induce multiple interactions. After taking goshuyuto combined with sodium valproate, no further migraine occurred for 3 months and no AF was observed. Conclusion: The kampo extract goshuyuto may be an option to prevent paroxysmal AF associated with migraine attack.