Triptan-induced latent sensitization a possible basis for medication overuse headache

Milena De Felice, Michael H. Ossipov, Ruizhong Wang, Josephine Lai, Juliana Chichorro, Ian Meng, David W. Dodick, Todd W. Vanderah, Gregory Dussor, Frank Porreca

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113 Scopus citations

Abstract

Objective: Identification of the neural mechanisms underlying medication overuse headache resulting from triptans. Methods: Triptans were administered systemically to rats by repeated intermittent injections or by continuous infusion over 6 days. Periorbital and hind paw sensory thresholds were measured to detect cutaneous allodynia. Immunofluorescent histochemistry was employed to detect changes in peptidic neurotransmitter expression in identified dural afferents. Enzyme-linked immunoabsorbent assay was used to measure calcitonin gene-related peptide (CGRP) levels in blood. Results: Sustained or repeated administration of triptans to rats elicited time-dependent and reversible cutaneous tactile allodynia that was maintained throughout and transiently after drug delivery. Triptan administration increased labeling for CGRP in identified trigeminal dural afferents that persisted long after discontinuation of triptan exposure. Two weeks after triptan exposure, when sensory thresholds returned to baseline levels, rats showed enhanced cutaneous allodynia and increased CGRP in the blood following challenge with a nitric oxide donor. Triptan treatment thus induces a state of latent sensitization characterized by persistent pronociceptive neural adaptations in dural afferents and enhanced responses to an established trigger of migraine headache in humans. Interpretation: Triptans represent the treatment of choice for moderate and severe migraine headaches. However, triptan overuse can lead to an increased frequency of migraine headache. Overuse of these medications could induce neural adaptations that result in a state of latent sensitization, which might increase sensitivity to migraine triggers. The latent sensitization could provide a mechanistic basis for the transformation of migraine to medication overuse headache.

Original languageEnglish (US)
Pages (from-to)325-337
Number of pages13
JournalAnnals of Neurology
Volume67
Issue number3
DOIs
StatePublished - Mar 2010

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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    De Felice, M., Ossipov, M. H., Wang, R., Lai, J., Chichorro, J., Meng, I., Dodick, D. W., Vanderah, T. W., Dussor, G., & Porreca, F. (2010). Triptan-induced latent sensitization a possible basis for medication overuse headache. Annals of Neurology, 67(3), 325-337. https://doi.org/10.1002/ana.21897