Background

Studying a spontaneous migraine attack is challenging, particularly the earliest components. Nitroglycerin is a potent, reliable and reproducible migraine trigger of the entirety of the migraine attack, making its use experimentally attractive.

Methods

Fifty-three subjects with migraine with a history of spontaneous premonitory symptoms were exposed to a 0.5 mcg/kg/min nitroglycerin infusion. Eighty-three percent (n = 44) developed typical premonitory and headache symptomatology. Fifty-seven percent (n = 25) were invited back to further study visits, during which they were re-exposed to nitroglycerin or placebo infusion in a double-blind randomised design. The phenotype of premonitory symptoms and headache was captured and compared to spontaneous attacks and between triggered attacks using agreement analysis.

Results

More premonitory symptoms were triggered with nitroglycerin than placebo (mean symptom difference = 4, t₂₀ = 7.06, p < 0.001). The agreement in triggering for the most commonly reported premonitory symptoms (concentration difficulty and tiredness) was >66%. The retriggering agreement for all but one premonitory symptom was >60%. The agreement in timing to onset of premonitory symptoms was reliable across two triggered attacks. The agreement with spontaneous attacks and between attacks for headache and its associated symptoms, including laterality, was less reliable.

Conclusions

Nitroglycerin can reliably and reproducibly provoke premonitory symptomatology associated with migraine. This forms an ideal model to study the earliest manifestations of migraine attacks.

中文翻译：

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偏头痛患者中硝酸甘油引起的头痛和非头痛症状：一项人体药理学触发研究。

背景

研究自发性偏头痛发作具有挑战性，尤其是最早的成分。硝酸甘油是整个偏头痛发作的有效、可靠和可重复的偏头痛触发器，使其在实验上具有吸引力。

方法

53 名有自发性先兆症状病史的偏头痛受试者接受了 0.5 mcg/kg/min 硝酸甘油输注。83% (n = 44) 出现了典型的先兆和头痛症状。57% (n = 25) 被邀请返回进一步的研究访问，在此期间，他们在双盲随机设计中再次接受硝酸甘油或安慰剂输注。使用一致性分析捕获先兆症状和头痛的表型，并将其与自发性发作和触发性发作之间进行比较。

结果

与安慰剂相比，硝酸甘油引发的先兆症状更多（平均症状差异 = 4，t ₂₀  = 7.06，p  < 0.001）。触发最常见的先兆症状（注意力不集中和疲倦）的一致性>66%。除一种先兆症状外，其他所有症状的重新触发一致性>60%。在两次触发的攻击中，先兆症状出现的时间一致是可靠的。与自发性发作以及头痛及其相关症状（包括偏侧性）发作之间的一致性不太可靠。

结论

硝酸甘油可以可靠且可重复地引起与偏头痛相关的先兆症状。这形成了研究偏头痛发作最早表现的理想模型。