Warfarin treatment and migraine

Suresh, Cheriyil G.; Neal, Deborah; Coupe, Michael

doi:10.1136/pgmj.70.819.37

Cited by 21 publications

(35 citation statements)

References 4 publications

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“…38 Thus, the improvement that we detected in both groups was well expected. In earlier studies, we and others observed a greater enhancement in QoL in patients having lower baseline scores, 9,39 which rationalizes the greater degree of QoL improvement in group 1 than in group 2, in this study. Lack of substantial change in bodily pain in the SF-36 scales can be attributed to age-related comorbidities, such as osteoporosis, arthritis, joint replacement in our mostly elderly study population.…”

Section: Improvement In Qolmentioning

confidence: 54%

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Effect of Catheter Ablation and Periprocedural Anticoagulation Regimen on the Clinical Course of Migraine in Atrial Fibrillation Patients With or Without Pre-Existent Migraine

Mohanty

Rutledge

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background— We examined the influence of catheter ablation and periprocedural anticoagulation regimen on trajectory of migraine in atrial fibrillation patients with or without migraine history. Methods and Results— Forty patients with (group 1: 64±8 years; men 78%) and 85 (group 2: 61±10 years; men 73%) without migraine history undergoing atrial fibrillation-ablation were enrolled. Migraine status and quality of life were evaluated using standardized questionnaires. Diffusion magnetic resonance imaging of brain was performed for all at pre and 24 hours post procedure. Catheter ablation was performed with (88, 70%) or without (37, 30%) continuous warfarin treatment. Fifty-four patients (11 and 43 from groups 1 and 2, respectively) had subtherapeutic international normalized ratio on procedure day. At 17±5 months follow-up, from group 1, 25 (63%) reported no migraine, 10 (25%) had <1, and 3 (8%) had 2 to 3 monthly symptoms. Intensity of pain decreased from baseline 7 (Q1–Q3, 4–8) to 2 (0–4) scale points at follow-up ( P <0.001) and duration of headache from median 8 (Q1–Q3, 4–15) to 0.5 (Q1–Q3, 0–2) hours ( P <0.001). Two patients from group 1 reported increased migraine severity and 2 from group 2 had new-onset migraine. Follow-up diffusion magnetic resonance imaging revealed new infarcts in 9.6% (12/125) patients; of which 11 had subtherapeutic preprocedural international normalized ratio on or off continuous warfarin. Quality of life improved significantly in patients with successful ablation, being more pronounced in group 1. Conclusions— In most patients, migraine symptoms improved substantially after catheter ablation. Interestingly, the only cases of new migraine and aggravation of pre-existent headache had subtherapeutic international normalized ratio during the procedure and new cerebral infarcts.

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Section: Improvement In Qolmentioning

confidence: 54%

“…8,9 Warfarin is routinely prescribed to patients undergoing radiofrequency CA to prevent thromboembolic events. Therefore, our study also explored the impact of therapeutic warfarin on the prevalence and clinical course of migraine in patients with or without a previous history.…”

Section: Circ Arrhythm Electrophysiolmentioning

confidence: 99%

Effect of Catheter Ablation and Periprocedural Anticoagulation Regimen on the Clinical Course of Migraine in Atrial Fibrillation Patients With or Without Pre-Existent Migraine

Mohanty

Rutledge

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…[1][2][3] Two recent cases involved patients aged 71 years 1 and 68 years, 2 the latter reporting that substitution of warfarin by placebo resulted in the return of migraine attacks. Robbins reported that migraine attacks suffered by three young females with high levels of anticardiolipin antibodies decreased during treatment with warfarin.…”

Section: Commentsmentioning

confidence: 99%

Reduction of Migraine Attacks During the Use of Warfarin

Fragoso¹

1997

Headache

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Two recent reports on reduction of migraine attacks during treatment with vitamin K antagonists have caught my attention. 1,2 Being a migraine sufferer myself, with considerable improvement of my headache during the use of warfarin, I became interested in the subject. Recently, a young man sought my advice for migraine attacks which had worsened after the withdrawal of warfarin. The previous reports on migraine and warfarin involved elderly patients. 1,2 I report now on these two patients in their 30s, one of them being myself (case 1), who have experienced reduction of migraine attacks during the use of warfarin.Key words: migraine, warfarin (Headache 1997;37:667-668) CASE HISTORIES Case 1.-A 39-year-old woman had suffered migraine attacks since childhood. The migraine was both with and without aura, and visual auras not followed by headache were frequent. The headache was moderate/intense with the usual autonomic symptoms which accompany these attacks. The frequency of attacks was one to two per week and visual auras with no headaches were even more frequent. Prophylactic treatment with flunarizine had not improved the headache or the visual disturbances.In May 1994, due to mitral valve stenosis, atrial fibrillation, and pulmonary embolism, heparin was administered for 3 days, after which warfarin 5 mg/ day was started. The International Normalization Ratio (INR) was kept at 2.5. Digoxin 0.25 mg/day was also prescribed. These medications were continued for 15 months, during which the frequency and intensity of the headache attacks decreased to less than one attack per month, of moderate intensity. The frequency of visual auras without headache was reduced as well, though episodes of aura were still present at least once a week. During mitral valve commissurotomy in December 1994, warfarin was discontinued and the headache returned with nearly daily frequency, though this was attributed to the surgical stress. Warfarin was restarted a week after the surgery and continued for another 8 months, during which period the headache was again very rare. Due to the reduction of the size of the left atrium and return to sinus rhythm, warfarin was discontinued in August 1996. Ten days later, the headache returned with the same characteristics, frequency, and intensity which were observed before warfarin. Propranolol 20 mg/day was added to digoxin due to episodes of sinus tachycardia, but the headache profile has not altered.Case 2.-A 34-year-old man underwent stomach surgery in March 1996. Two weeks later, the patient developed deep venous thrombosis and was treated with subcutaneous heparin for 1 month, after which warfarin 5 mg/day was started. The INR was kept at 2.5. Bromazepam 3 mg/day was also prescribed. The patient, who presented occasional attacks (once a month or less) of migraine without aura for many years, became headache-free for the 5-month period of treatment with warfarin. Two weeks after discontinuation of this medication, the patient began to have frequent attacks of migraine and dizziness. His compl...

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“…Key words: anticoagulation, impact, migraine, ergotamine, sumatriptan, consumption Abbreviations: DDDs defined daily doses, OAC oral anticoagulation with coumarin derivatives, ASA acetylsalicylic acid ( Headache 2001;41:768-773) A few case reports have described a complete resolution of migraine or a substantial reduction in frequency and intensity of migraine attacks in migraineurs with or without aura during treatment with oral anticoagulant drugs, such as warfarin or acenocoumarol. [1][2][3][4] In addition, a recent patient questionnaire study in 400 subjects treated with acenocoumarol for nonneurological indications revealed that oral anticoagulation produced improvement of headache in 63% of patients with migraine versus 38% of patients with nonmigrainous headache. 5 Although the…”

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confidence: 99%

“…[1][2][3][4] In addition, a recent patient questionnaire study in 400 subjects treated with acenocoumarol for nonneurological indications revealed that oral anticoagulation produced improvement of headache in 63% of patients with migraine versus 38% of patients with nonmigrainous headache. 5 Although the underlying mechanism associated with the possible improvement of migraine symptoms due to coumarin therapy has not been fully elucidated, there is evidence that during migraine attacks there is an increase in platelet aggregability and plasma coagulability.…”

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confidence: 99%

Reduction in the Intensity of Abortive Migraine Drug Use During Coumarin Therapy

et al. 2001

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Objective.-To investigate the impact of coumarin therapy on migraine attack frequency. Background.-Sporadic case reports and clinical studies have described beneficial effects of coumarin therapy on migraine severity.Design and Methods.-A retrospective follow-up study based on a prescription database covering a population of 450000 was conducted. All patients using an abortive migraine drug (ergotamine or sumatriptan) and subsequently treated with either coumarin (index group) or low-dose acetylsalicylic acid (control group) were analyzed. The impact of coumarin and low-dose acetylsalicylic acid on the frequency of migraine attacks was assessed by measuring the intensity of ergotamine and sumatriptan use, in defined daily doses per month per patient, before and during coumarin or acetylsalicylic acid treatment. In addition, a "therapeutic intensity reduction" was determined for each patient.Results.-The study population consisted of 92 patients; 35% had been prescribed coumarin and 65% had been prescribed low-dose acetylsalicylic acid after the initiation of ergotamine or sumatriptan. Two thirds of the study population was treated with ergotamine. Overall, ergotamine and sumatriptan use for the coumarin cohort decreased from 6.4 defined daily doses per month prior to coumarin treatment to 3.0 defined daily doses during coumarin treatment, compared with a reduction from 5.2 defined daily doses per month to 4.4 defined daily doses per month for the lowdose acetylsalicylic acid cohort ( P Ͼ .05). The therapeutic intensity of ergotamine and sumatriptan use was significantly decreased by 40% for the coumarin cohort, compared with 4.7% for the low-dose acetylsalicylic acid cohort (P ϭ .004).Conclusions.-We observed that coumarin treatment was clearly associated with a reduction in the therapeutic intensity of abortive migraine drug use in comparison with low-dose aspirin treatment. This suggests that, overall, the coumarin cohort had experienced a substantial reduction in the frequency of migraine attacks during anticoagulation treatment. Our findings, as well as those of others, justify a controlled clinical trial to further establish the effects of coumarin therapy on migraine severity and its possible role in the prophylactic management of patients suffering from migraine. Key words: anticoagulation, impact, migraine, ergotamine, sumatriptan, consumption Abbreviations: DDDs defined daily doses, OAC oral anticoagulation with coumarin derivatives, ASA acetylsalicylic acid ( Headache 2001;41:768-773) A few case reports have described a complete resolution of migraine or a substantial reduction in frequency and intensity of migraine attacks in migraineurs with or without aura during treatment with oral anticoagulant drugs, such as warfarin or acenocoumarol. [1][2][3][4] In addition, a recent patient questionnaire study in 400 subjects treated with acenocoumarol for nonneurological indications revealed that oral anticoagulation produced improvement of headache in 63% of patients with migraine versus 38% of patients w...

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Warfarin treatment and migraine

Cited by 21 publications

References 4 publications

Effect of Catheter Ablation and Periprocedural Anticoagulation Regimen on the Clinical Course of Migraine in Atrial Fibrillation Patients With or Without Pre-Existent Migraine

Effect of Catheter Ablation and Periprocedural Anticoagulation Regimen on the Clinical Course of Migraine in Atrial Fibrillation Patients With or Without Pre-Existent Migraine

Reduction of Migraine Attacks During the Use of Warfarin

Reduction in the Intensity of Abortive Migraine Drug Use During Coumarin Therapy

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