Anti-Migraine Drugs Might Cause More Pain Than Relief For Those With Heart Disease

July 06, 1998

DALLAS, Texas, July 7 -- As if lowering risk factors for heart attack isn't headache enough, researchers report that migraine sufferers with established heart disease shouldn't take certain anti-migraine medications.

Dutch researchers report in today's Circulation: Journal of the American Heart Association that studies of blood vessels in the lab show that several migraine medications cause the vessels feeding the heart to contract. If these vessels, called coronary arteries, are already narrowed by heart disease, the contraction effects of the migraine drugs can tip the balance, resulting in chest pain and even heart attacks.

For individuals whose blood circulation is not slowed by heart disease, the scientists say that the migraine drug's contraction effects should not be dangerous.

"For most migraine sufferers this is not a problem," says Antoinette MaassenVanDenBrink, postgraduate student, pharmacology department, Erasmus University. "But if the coronary artery is already narrowed, there might not be enough reserve. In such cases, a small additional contraction may cause problems."

Therefore, doctors should be cautious about prescribing anti-migraine medications to people with established heart disease. Patients with risk factors for heart disease -- such as high blood pressure or cholesterol -- should not be prescribed this medication without a thorough evaluation showing the patient is free of heart disease, she says.

The researchers studied the coronary arteries' reaction to several anti-migraine medications after reports of chest pain and heart attack in some patients given drugs for migraine headaches. Manufacturers of some of the newer drugs have suggested their drugs are less likely to cause this type of problem, she says. However, scientists found that the drugs had similar effects on artery narrowing.

The researchers took 14 arteries from organ donors who had died from non-cardiac reasons. After measuring each artery's ability to contract and relax, they tested each drug's effect on the arteries. The drugs tested included older drugs such as ergotamine, dihydroergotamine, methysergide and its metabolite methylergometrine as well as newer drugs such as sumatriptan, naratriptan, zolmitriptan and rizatriptan.

Compared to sumatriptan, all drugs were more apt to cause the coronary arteries to contract, but are administered to patients in lower doses. The researchers determined the maximum contraction response of the arteries elicited by the drugs and the concentration of the drug required to achieve half of that maximum contraction. These values were compared to the maximum concentrations of the drugs in the blood and given a ratio.

"As far as we can predict, the compound's action is quite similar in the coronary arteries," MaassenVanDenBrink says.

But when the researchers gave in higher concentrations of the drugs and then attempted to wash them from the arteries, the artery contractions from most of the drugs decreased. However, two of the older drugs -- ergotamine and dihydroergotamine -- continued to act on the artery walls resulting in contractions. "They were much longer acting," she says. "Even after the concentrations of the drug surrounding the vessel fell, these two drugs were still acting. This is a disadvantage."

Ergotamine continued to cause artery wall contractions for up to 90 minutes, while sumatriptan and the other triptans were nearly completely gone in 30 minutes, she says.

The anti-migraine drugs, she says, are highly effective in aborting attacks of migraine headaches. However, with sumatriptan, 15 percent of patients consistently reported symptoms including pressure, tightness and pain in the chest. MaassenVanDenBrink says migraine headaches probably are caused by dilation of blood vessels in the head but located outside the brain, resulting in inflammation of tissue surrounding the vessels.

The medications "cause constriction of the vessels, relieving the headache," she says. "But constriction occurs not only in the head vessels, but also the coronary arteries."

Other researchers involved in the study included Marije Reekers, undergraduate student, Leiden University Medical Center, Rotterdam; Willem Bax, M.D., Ph.D., formerly at Erasmus University, presently at Eemland Hospital, Amersfoort; Michel D. Ferrari, M.D., Ph.D., neurologist, Leiden University Medical Center; and Pramod R. Saxena, M.D., Ph.D., chairman and professor of pharmacology, Erasmus University, Rotterdam, Netherlands.
NR 98-4917 (Circ/Vand)

Media advisory: MaasenVanDenBrink can be reached by phone at 3110 408 7537, by fax at 3110 436 6839, or by email at
(Please do not publish numbers.)

American Heart Association

Related Heart Disease Articles from Brightsurf:

Cellular pathway of genetic heart disease similar to neurodegenerative disease
Research on a genetic heart disease has uncovered a new and unexpected mechanism for heart failure.

Mechanism linking gum disease to heart disease, other inflammatory conditions discovered
The link between periodontal (gum) disease and other inflammatory conditions such as heart disease and diabetes has long been established, but the mechanism behind that association has, until now, remained a mystery.

New 'atlas' of human heart cells first step toward precision treatments for heart disease
Scientists have for the first time documented all of the different cell types and genes expressed in the healthy human heart, in research published in the journal Nature.

With a heavy heart: How men and women develop heart disease differently
A new study by researchers from McGill University has uncovered that minerals causing aortic heart valve blockage in men and women are different, a discovery that could change how heart disease is diagnosed and treated.

Heart-healthy diets are naturally low in dietary cholesterol and can help to reduce the risk of heart disease and stroke
Eating a heart-healthy dietary pattern rich in vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, vegetable oils and nuts, which is also limits salt, red and processed meats, refined-carbohydrates and added sugars, is relatively low in dietary cholesterol and supports healthy levels of artery-clogging LDL cholesterol.

Pacemakers can improve heart function in patients with chemotherapy-induced heart disease
Research has shown that treating chemotherapy-induced cardiomyopathy with commercially available cardiac resynchronization therapy (CRT) delivered through a surgically implanted defibrillator or pacemaker can significantly improve patient outcomes.

Arsenic in drinking water may change heart structure raising risk of heart disease
Drinking water that is contaminated with arsenic may lead to thickening of the heart's main pumping chamber in young adults, according to a new study by researchers at Columbia University Mailman School of Public Health.

New health calculator can help predict heart disease risk, estimate heart age
A new online health calculator can help people determine their risk of heart disease, as well as their heart age, accounting for sociodemographic factors such as ethnicity, sense of belonging and education, as well as health status and lifestyle behaviors.

Wide variation in rate of death between VA hospitals for patients with heart disease, heart failure
Death rates for veterans with ischemic heart disease and chronic heart failure varied widely across the Veterans Affairs (VA) health care system from 2010 to 2014, which could suggest differences in the quality of cardiovascular health care provided by VA medical centers.

Heart failure: The Alzheimer's disease of the heart?
Similar to how protein clumps build up in the brain in people with some neurodegenerative diseases such as Alzheimer's and Parkinson's diseases, protein clumps appear to accumulate in the diseased hearts of mice and people with heart failure, according to a team led by Johns Hopkins University researchers.

Read More: Heart Disease News and Heart Disease Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to