A New Benign Sexual Headache: Sildenafil (Viagra®)-Induced Migraine
A New Benign Sexual Headache: Sildenafil (Viagra®)-Induced Migraine
Abstract & Commentary
Source: Kruuse C, et al. Migraine can be induced by sildenafil without changes in middle cerebral artery diameter. Brain. 2003;126:241-247.
According to the PDR,1 16% of patients using sildenafil in clinical trials reported headache compared with only 4% of controls. Kruuse and associates studied the effect of sildenafil use apart from sexual activity in 12 patients with a history of migraine without an aura. In a double-blind, placebo-controlled crossover study, sildenafil 100 mg or placebo was administered orally on 2 separate days. Middle cerebral artery blood flow velocity (Vmca) was recorded by transcranial Doppler ultrasonography, and regional cerebral blood flow (rCBF) was measured using SPECT and Xenon133 inhalation.
Migraine attacks were induced by sildenafil in 10/12 migraine patients and by placebo in 2 of 12 (P = 0.01). Sildenafil did not affect Vmca, rCBF, temporal or radial artery diameter, tenderness of pericranial vessels, or blood pressure. Heart rate increased significantly from a mean of 62 ± 2 before to 74 ± 3 beats/min after sildenafil (P = 0.01).
Sildenafil is a selective inhibitor of the cyclic guanosine monophosphate (cGMP)-degrading enzyme phosphodiesterase 5 (PDE5). PDE5 is located in several different sites throughout the body, including the vascular smooth muscle of the penis where it regulates vascular tone. The effects of sildenafil on cerebral artery tone are unknown.
In the present study, migraine headaches induced by sildenafil occurred without an initial dilatation of the MCA. Therefore, Kruuse et al postulate that a sildenafil-induced increase in cGMP may affect headache-triggering mechanisms within perivascular sensory nerve terminals, the brainstem, or at other sites.
Commentary
In the popular mind, the best-known association between headache and sexual activity is that the former is used as an excuse to avoid the latter. Neurologists, however, recognize the role of sexual activity as a precipitant of headache and term as coital or orgasmic cephalgia benign headaches occurring at orgasm and rapidly subsiding thereafter.
In the present study, Kruuse et al found that sildenafil apart from any sexual activity induced headaches in 80% of migraine patients. It is not known whether sildenafil together with sexual activity also provokes orgasmic cephalgia and other forms of benign sexual headaches. So far, patient reporting suggests that this is not the case.
Nevertheless, this paper should remind clinicians to inquire about sildenafil use in patients reporting headaches, especially those related to sexual activity, and also to inform patients with a history of migraine headaches who plan to use sildenafil of the risk of migraine attacks. — John J. Caronna
Dr. Caronna is Vice-Chairman, Department of Neurology, Cornell University Medical Center; Professor of Clinical Neurology, New York Hospital.
Reference
1. Physicians’ Desk Reference. 57th ed. Montvale, NJ: Medical Economics Company Inc; 2003:2656.
According to the pdr,1 16% of patients using sildenafil in clinical trials reported headache compared with only 4% of controls. Kruuse and associates studied the effect of sildenafil use apart from sexual activity in 12 patients with a history of migraine without an aura.Subscribe Now for Access
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