Migraine-like Headache in a Patient with Complement 1 Inhibitor Deficient Hereditary Angioedema

We report on an angioedema patient with a genetic defect in complement 1 inhibitor, manifesting migraine-like episodes of headache, effective prophylaxis with Danazol, and triptan for a treatment of acute clinical episode. The patient was 44-yr-old Korean man with abdominal pain and headache, who was brought into the Emergency Department of Seoul National University Hospital, Seoul. He suffered from frequent attacks of migraine-like headache (3-7 per month), pulsating in nature associated with nausea. Severities were aggravated by activity and his headache had shown recent progression with abdominal pain. No remarkable findings were observed on radiologic examination, brain magnetic resonance images and intracranial and extracranial magnetic resonance angiography. Danazol 200 mg every other day was subsequently used. Following administration of Danazol, symptoms showed improvement and the patient was discharged. While taking Danazol, the migraine-like episodes appeared to be prevented for about 2 yr. At the eighth month, he suffered a moderate degree of migraine-like headache; however, administration of naratriptan 2.5 mg resolved his problem. A case of genetic defect of C1-INH deficiency presented with headache episodes, and was controlled by Danazol and triptan. It suggests that pathogenic mechanism of headache in hereditary angioedema may be mediated by the neurogenic inflammatory-like physiology of migraine.

Innervation of cerebral vessels and pathogenesis of migraine / 全日本鍼灸学会雑誌

Although migraine is not life-threatened disease, its burden in migraineurs is enough severe to affect the productivity in the society around them. Triptans, the most effective agents for the pain in the migraine attacks, have been available since 2000 in Japan. After then, the strategy for migraine treatment has been drastically changed. It has also affected the concept for migraine pathogenesis. Migraine has been attributed to certain abnormality in the cerebral blood vessels per se. However, the trigeminal nerve endings around cerebral or dural vessels are considered to play the key role in the migraine attacks since appearance of the triptans (i.e., trigeminovascular theory). Moreover, recent researches imply many possibilities of the 'migraine generator(s)'in the central nervous system.

The Diagnosis and Most-Updated Therapy of Migraine

Migraine is a very common headache disorder. The international headache society subdivides migraine into the ones with and without aura. The migraine attack can consist of premonitory, aura, headache, and resolution phases. Diagnosis is based on the characteristics of headache and associated symptoms. There are many abortive and preventive migraine treatments. Abortive treatment is either specific for the disease or nonspecific such as analgesics. The migraine specific therapies are representative of new migraine abortive medications, which act as serotonin agonist-triptan and ergot. Stratified care and early treatment are also cost-effective. Increased headache frequency is an indication for a preventive treatment. Preventive treatment decreases migraine frequency and improves quality of life. More treatments are being developed. Several new treatments are reviewed in this article.