Nitrates for the Early Treatment of Classical Migraine.

Treat the Aura and Abort the Pain

The term classical migraine usually refers to a recurring unilateral headache that is preceded by an aura that can be a range of sensations most frequently to do with vision. The subject usually has their own set of visual changes that can involve partial loss of vision followed within minutes by flashing lights that can range from relatively simple light flashes through to the so called fortification spectra where patterns of brightly coloured neon tube like lights form complex geometric patterns that can persist for minutes and occasionally for hours.

Some subjects do not progress beyond the visual changes but most patients describe progression to severe throbbing pain that is often worsened by noise and bright light. Nausea and vomiting are not infrequent and no single treatment works for all patients as witnessed by the plethora of treatments that are currently on offer.

As there does not appear to be a single effective treatment for all classical migraine subjects there seems little reason to NOT add one more tool to the physicians' armamentarium.

Over the years I have spent treating various types of headaches including classical migraines I have found that some subjects with so called classical migraines can be well helped by the use of sublingual nitrates if they are administered preferably at the first sign or at least within minutes of the commencement of the patient's own typical visual aura.

The advent of Glyceryl Nitrate sprays such as Nitrolingual Pumpspray has greatly aided this treatment as the sprays seem to not lose their efficacy and last for many months under a range of conditions and are easily carried.

The treatment is easily administered: The patient is told to sit or lie down at the first sign of their aura. Then to self administer one or two puffs of Nitrolingual spray sub-lingually. Wait for 5-10 minutes and if the aura persists repeat the dose. (Anginine Tablets 1/2 to 1 can be substituted but as these are not heat stable and deteriorate relatively rapidly I feel that the Nitrolingual spray is preferable)

The subject should be warned that they may get a mild throbbing headache immediately following 2 sprays (doses) and if this occurs to try one puff at a time. Other warnings include the chance of postural hypotension and even though I have not witnessed it the possibility of an exacerbation.

Treatment outcome: Those that get cessation of their visual aura within minutes following the Glyceryl Nitrate spray do not progress to the painful stage of their headache.

There are many anecdotal stories that reference Nitrates, perhaps as the result of confusion with Nitrites, as migraine triggers... hence the above advice will at times meet initial resistance. However patients seem to accept the explanation that as the aura has already commenced that there is already some diminution of cerebral blood flow and that the Glyceryl Nitrate is aimed at reversing that rapidly, hence aborting the bodies inflammatory response to, relatively prolonged, ischaemia.

I would be interested to hear if other practitioners have had or have similar results using the technique described above. Please email: 1@Intaanetto.com and tell me your story.