The Elusive Role of Thrombin in Migraine

Carramate, Jorge Filipe Pereira; Fragoso, Yára Dadalti; Carvalho, Diana Paula de Souza Rêgo Pinto; Gabbai, Alberto Alain

doi:10.1046/j.1526-4610.2001.041006609.x

Cited by 3 publications

(3 citation statements)

References 28 publications

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“… 33 Because anticoagulation has been reported to improve migraine, it is tempting to speculate that thrombin may have a role in the pathogenesis of migraine causing neurogenic inflammation that would favor and perpetuate a migraine attack. 34 …”

Section: Discussionmentioning

confidence: 99%

Migraine in Patients Undergoing PFO Closure

Trabattoni

Brambilla

Canzano

et al. 2022

JACC: Basic to Translational Science

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Section: Discussionmentioning

confidence: 99%

Migraine in Patients Undergoing PFO Closure

Trabattoni

Brambilla

Canzano

et al. 2022

JACC: Basic to Translational Science

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“…25 Pro-inflammatory mediators are released through activation of PAR1, while the activation of PAR2 induces the release of substance P and calcitonin-gene-related peptide (CGRP). 26 Expressed in astrocytes, microglia and neurons, PAR1 has been described as a well-positioned receptor to play a central role mediating the complex inflammatory cascades within the central nervous system, 29,30 It is, therefore, perfectly plausible that thrombin might be involved in the inflammatory trigeminovascular cascade of events in migraine.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the beneficial effects of thrombin and vitamin K inhibitors on migraine treatment

Nogueira¹,

Couto²,

Grossi³

et al. 2019

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Background: Prophylactic migraine therapy includes beta-blockers, anticonvulsants, tricyclic antidepressants and calcium channel modulators. These drugs have been serendipitously identified as agents capable of migraine control. In order to reduce drug intake, interactions and potential adverse events, patients who have high blood pressure and migraine are often prescribed beta-blockers or calcium channel antagonists. Patients with epilepsy and migraine can use anticonvulsants, those with depression and migraine can be treat with antidepressants, and those with heart arrhythmia or recurrent vertigo and concomitant migraine can benefit from use of calcium channel antagonists. The beneficial effects of vitamin K or thrombin inhibitors on migraine attacks were first described decades ago, and there may be a place for these drugs in migraine prophylaxis. Objective: To investigate the potential beneficial effects of this class of anticoagulants regarding prevention of migraine attacks. Method: Systematic review of the literature including papers with patients’ results. Results: A search of the literature yielded 16 papers with data on patients using inhibitors of vitamin K or thrombin for thromboembolic conditions. Articles typically reported on single cases or small case series. In all but one of these reports, the effect of the drug was remarkable in decreasing migraine severity. Conclusion: Although the level of recommendation is low due to the lack of proper clinical trials, vitamin K or thrombin inhibitors may be useful for migraine management in patients who also require anticoagulation. For these individuals, use of this class of anticoagulants could avoid adding extra drugs for migraine management.

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“…Isolated reports of a possible positive effect of anticoagulant drugs, among them heparin, warfarin and acenocumarol, in migraine prophylaxis [1][2][3][4][5] are found in the literature. We do not know references to a prophylactic action of these same drugs on cluster headache.…”

Section: Palavras-chave: Cefaléia Em Salvas Varfarinamentioning

confidence: 99%

Remission of refractory chronic cluster headache after warfarin administrations: case report

Souza

Filho

Jevoux

et al. 2004

Arq. Neuro-Psiquiatr.

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-Isolated reports of a possible positive effect of anti-coagulant drugs, among them heparin, warfarin and acenocumarol, in migraine prophylaxis are found in the literature. We report the case of a 37 years old man suffering from refractory chronic cluster headache that presented remission with the administration of warfarin for the treatment of deep venous thrombosis associated to arterial thrombosis. We did not found any case like that in the literature.KEY WORDS: cluster headache, warfarin.Remissão de cefaléia em salvas crônica refratária após administração de varfarina: relato de caso RESUMO -Alguns relatos isolados na literatura referem-se a um possível efeito profilático de drogas anticoagulantes, entre elas a heparina, varfarina e acenocumarol na profilaxia da migrânea. Apresentamos o caso de um homem de 37 anos com cefaléia em salvas crônica refratária que obteve remissão total das crises após a administração de varfarina para o tratamento de trombose venosa e arterial. Não encontramos nenhum relato semelhante na literatura consultada. PALAVRAS-CHAVE: cefaléia em salvas, varfarina.Isolated reports of a possible positive effect of anticoagulant drugs, among them heparin, warfarin and acenocumarol, in migraine prophylaxis [1][2][3][4][5] are found in the literature. We do not know references to a prophylactic action of these same drugs on cluster headache. We report the case of a patient suffering from chronic cluster headache, up to this point refractory to the treatment and that presented remission with the administration of warfarin for the treatment of deep venous thrombosis associated to arterial thrombosis. CASEA 37 years old white man, salesman, searched medical care due to headache complaint, for the first time, on December 1997. At that time, he reported that the headache had started about two months ago and, since then, he experienced pain with a frequency of one to two crises a day. Headache was described as very strong, obligating the patient to interrupt all and any activity. The pain was invariably located on the left orbit, periorbital and temporal regions, and never changed side. During crises, the patient used to be unquiet, walking around, with the hand open against the painful eye. Together with the headache, the patient presented conjunctival injection, eyelid ptosis, nasal congestion and excessive tearing, only on the pain side. These manifestations lasted a time varying from 45 min to 120 minutes. About a third of pain crises occurred during the sleeptime, awakening the patient. The patient was previously healthy and never presented a similar picture before. He also had never been subjected to recurring headache. Neurological examination revealed only a left Horner's syndrome. Blood pressure was normal (130 X 80 mmHg).Because a so characteristic manifestation, the diagnosis of cluster headache was established and treatment was started with a course of prednisone (60 mg/day) and verapamil (240 mg/day). In order to abort the crises, we gave a prescription of subcutaneous sumatri...

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The Elusive Role of Thrombin in Migraine

Cited by 3 publications

References 28 publications

Migraine in Patients Undergoing PFO Closure

Migraine in Patients Undergoing PFO Closure

Systematic review of the beneficial effects of thrombin and vitamin K inhibitors on migraine treatment

Remission of refractory chronic cluster headache after warfarin administrations: case report

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