Browsing by Subject "Migraine Disorders"

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    Assessing acute systemic effects of an inhaled drug with serial echocardiography: a placebo-controlled comparison of inhaled and intravenous dihydroergotamine.
    (Drug Des Devel Ther, 2013) Noveck, Robert J; Douglas, Pamela S; Chow, Shein-Chung; Mangum, Barry; Kori, Shashidhar; Kellerman, Donald J
    OBJECTIVE: MAP0004 is an investigational product which delivers dihydroergotamine (DHE) through the lung via a breath-synchronized metered dose inhaler. The objective of this study was to compare the acute effects of orally inhaled and intravenous (IV) DHE to placebo on maximum change and area under the curve for pulmonary arterial systolic pressure (PASP). RESEARCH DESIGN AND METHODS: A randomized, double-blind, placebo-controlled, 3-period, crossover study of 24 health adults. Trial registration NCT01089062. Study assessments included pharmacokinetics, electrocardiograms (ECG), and validated echocardiographic (Doppler)-derived measures of PASP by echocardiogram. The primary endpoint was the absolute change in calculated PASP using area under the curve, 0 to 2 hours (AUC(0-2h)). RESULTS: The change in PASP with IV DHE was significantly different than MAP0004 and placebo (AUC(0-2h)2857, 2624, and 2453 mmHg*min, respectively). After a second dose of MAP0004, AUC(0-4h) remained lower with MAP0004 than with a single dose of IV DHE. Adverse events were more common with IV DHE than with MAP0004 or placebo. None of the treatments produced clinically significant changes in PASP or other cardiac parameters. Changes in PASP were significantly smaller with MAP0004 compared with IV DHE. CONCLUSION: These results indicate the effects 1 mg of orally inhaled DHE on the cardiovascular system are less than with 1 mg of IV DHE, and that serial echocardiography can be a useful noninvasive means of assessing acute systemic effects.
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    Migraine headaches following mitral valvuloplasty: Koch's postulates finally satisfied?
    (J Invasive Cardiol, 2013-06) Abernethy, Abraham; Ruiz-Rodriguez, Ernesto; Krasuski, Richard A
    The relationship between patent foramen ovale and migraine headache is a topic surrounded by much controversy. We present the case of a 45-year-old woman who underwent successful percutaneous mitral balloon valvuloplasty for rheumatic mitral valve stenosis, but had an immediate postprocedural course complicated by refractory migraine headaches. Interestingly, resolution of her headaches coincided with the spontaneous closure of the interatrial communication created during valvuloplasty. This suggests interatrial flow as an important trigger for migraine headaches in this patient.