Scopolamine-induced migraine like headache.

OBJECTIVE Scopolamine butylbromide (SB), a muscarinic receptor antagonist, is used commonly in gastric X-ray examination in the physical check-up in Japan. This study describes clinical features of SB-induced headache. PATIENTS AND METHODS SB-induced headache was defined as headache that started within 20 minutes after intramuscular administration of SB (20 mg/body). The Primary and the secondary headaches were diagnosed according to the ICHD-II criteria. SB-induced headache was classified as headache induced by acute substance use or that due to exposure (ICHD-II code 8.1). Clinical features and background of subjects with SB-induced headache were analyzed. We also estimated the frequency of SB-related headache between migraineurs and non-migraineurs. RESULTS A total of 54 subjects (39 women and 15 men) experienced SB-induced headache. All subjects had the present history of migraine. Nine subjects had > or =2 times of the headache. Mean age (SD) was 46.2 (9.7) years [46.2 (9.7) for women and 46.3 (10.0) for men]. Clinical hallmarks of headache showed that pulsating / throbbing pain occurred in diffuse or bilateral head sites. Headache worsened at 20-30 minutes from the onset and persisted for 6-18 hours, and ameliorated gradually 8 hours later. All subjects had repeated nausea and vomiting. Severity of headache revealed severe degree requiring complete bed rest in 50 subjects (92.6%). SB-induced headache had similar characteristics as migraine without aura (MO) attacks. Liver and renal functions were normal in all SB-related migraineurs. They had no allergic history of medication and food. In 1,865 non-migraine controls, one healthy subject had a mild degree of migraine like headache triggered by SB injection. CONCLUSION SB triggers a severe degree MO like headache or worsens pre-existing migraine in some migraineurs. SB-induced headache could contribute to disequilibrium between acetylcholine and other neuropeptides. We should use SB more carefully as it can be an aggravating drug of migraine.

[1]  R. Brunner,et al.  Effect of corticosteroids on short-term and long-term memory , 2005, Neurology.

[2]  P. Goadsby,et al.  Neurogenic vasodilation of dural blood vessels is not mediated by cholinergic transmission in the anaesthetised rat. , 2004, European journal of pharmacology.

[3]  Peter J. Goadsby,et al.  A Report on the Journal 2004 , 2004 .

[4]  C. Ghelardini,et al.  Central Cholinergic Challenging of Migraine by Testing Second‐Generation Anticholinesterase Drugs , 2002, Headache.

[5]  C. Ghelardini,et al.  Loss of muscarinic antinociception by antisense inhibition of M1 receptors , 2000, British journal of pharmacology.

[6]  L. Sokoloff,et al.  Cerebral blood flow responses to somatosensory stimulation are unaffected by scopolamine in unanesthetized rat. , 1999, The Journal of pharmacology and experimental therapeutics.

[7]  S. Peroutka.  Dopamine and migraine , 1997, Neurology.

[8]  G. Gessa,et al.  The central cholinergic system has a role in the antinociception induced in rodents and guinea pigs by the antimigraine drug sumatriptan. , 1996, Journal of Pharmacology and Experimental Therapeutics.

[9]  F. Tommasi,et al.  Video Assessment of Yawning Induced by Sublingual Apomorphine in Migraine , 1994, Headache.

[10]  T. Yaksh,et al.  Antinociceptive Effects of Spinal Cholinesterase Inhibition and Isobolographic Analysis of the Interaction with μ and α2 Receptor Systems , 1994 .

[11]  C. Gordon,et al.  Recurrent Classic Migraine Attacks Following Transdermal Scopolamine Intoxication , 1991, Headache.

[12]  O. Blin,et al.  Apomorphine-induced yawning in migraine patients: enhanced responsiveness. , 1991, Clinical neuropharmacology.

[13]  L. Beani,et al.  5‐HT1A agonists increase and 5‐HT3 agonists decrease acetylcholine efflux from the cerebral cortex of freely‐moving guinea‐pigs , 1990, British journal of pharmacology.

[14]  R. Dirksen,et al.  Antinociceptive effects of intrathecally injected cholinomimetic drugs in the rat and cat. , 1985, European journal of pharmacology.

[15]  C. Ghelardini,et al.  Involvement of central cholinergic system in antinociception induced by sumatriptan in mouse. , 1997, International journal of clinical pharmacology research.

[16]  J. Buccafusco,et al.  Antinociceptive effect of spinal cholinergic stimulation: interaction with substance P. , 1989, Life Science.