3 research outputs found
Cranial circulatory effects of antimigraine drugs: an experimental study in the pig
This thesis is main! y concerned with an investigation in anaesthetized pigs of the vascular
effects of sumatriptan, ergotamine and dihydroergotamine, drugs used in the treatment of
the acute migraine attack. There are several reasons for performing this investigation.
Firstly, a disturbance within the cranial blood vessels has long been implicated in
the pathogenesis of migraine. Such a vascular theory was first mentioned in 1684 by
Thomas Willis, following the discovery of the blood circulation by Harvey. Until the
middle of this century, an experimental basis for the vascular theory lacked, but it was
strengthened by the experiments of Graham & Wolff (1938), who demonstrated increased
pulsations of the superficial temporal artery in a proportion of their patients. More
recently the primarily vascular theory has been severely criticized by many researchers in
the field and a primarily neurological theory has been adopted. This theory involves
hyperactivity of the pain-conducting trigeminal nerve, leading to pain, but also dilatation
of the blood vessels innervated by this nerve (Markowitz eta!., 1988). Therefore, even
the leading neurological theory of this moment implies vascular involvement in the
migraine attack, even if not the primary cause.
Secondly the antimigraine drugs mentioned above are powerful vasoactive agents.
They usually constrict the carotid blood vessels, especially when they had been dilated
before (Saxena & De Vlaam-Schluter, 1974). It is, therefore, quite possible that a
vasoconstrictor action of these drugs contributes to the antimigraine activity. On the
other hand, it is now proposed, albeit not yet definitely proven, that a direct effect of
these drugs on the trigeminal nerve innervating the dura mater is a factor in their
antimigraine efficacy (Markowitz et aL, 1988; Buzzi & Moskowitz, 1990). A direct
vascular action could, however, even explain the effects of these drugs on the dura mater.
It is not known which blood vessels are mainly involved in migraine. The
pharmacological profile of the antimigraine drugs could provide a clue. The fact that
they are potent constrictors of arteries and arteriovenous anastomoses, but not of
arterioles (Miiller-Schweinitzer & Weidmann, 1978; Saxena, 1978; this thesis) could point
to involvement of arteries or arteriovenous anastomoses in migraine. For both some
experimental evidence is present (Heyck, 1969; Friberg eta!., 1991) The present thesis is aimed at contributing to the knowledge of the vascular
pharmacologic profile of these antimigraine drugs. The effect of these drugs on
arteriovenous anastomoses and arterioles both in the head and in the body (the effect on
arteries is beyond the scope of this thesis) was determined with injection of radioactive
microspheres in anaesthetized pigs. Furthermore, by use of suitable pharmacologic
agents an attempt was made to characterize the receptors involved in these vascular
effects. By a good pharmacological characterization it might, in future, be possible to
develop more specific antimigraine agents. Lastly, an attempt was made to determine the
neurotransmitter which may be responsible for the tonic contraction of the arteriovenous
anastomoses.
Before the presentation of the results of this investigation, chapters 2 through 4
will discuss in detail the field on which this thesis is based. In chapter 2 current views on
the pathophysiology of migraine will be discussed. Chapter 3 is concerned with previous
knowledge on the pharmacology of the antimigraine agents. In chapter 4 general features
of the cranial circulation are discussed, with the existing differences between the human
and porcine circulations. Chapter 6 will specify the aim of the thesis
NG-nitro L-arginine methyl ester: systemic and pulmonary haemodynamics, tissue blood flow and arteriovenous shunting in the pig
The effects of NG-nitro-Lrarginine methyl ester (L-NAME), an inhibitor of the endothelial nitric oxide (NO) biosynthesis, on systemic and pulmonary haemodynamics, and tissue as well as arteriovenous anastomotic blood flows were investigated in the anaesthetized pig, using simultaneous injections of radioactive microspheres of two different sizes (diameter: 15 and 50渭m). L-NAME (1, 3 and 10 mg路kg-1) reduced systemic and pulmonary artery conductance and cardiac output, but heart rate and mean arterial blood pressure remained unchanged. L-arginine reversed the systemic and pulmonary haemodynamic changes induced by L-NAME. As detected with 15 渭m microspheres, L-NAME (1 and 3 mg路kg-1) decreased tissue blood flow to and vascular conductance in the eyes, lungs, atria, kidneys, adrenals and liver. Furthermore, the difference between blood flows simultaneously measured with 15 and 50 渭m microspheres, which can be equated to blood flow through arteriovenous anastomoses with a diameter between about 28 and 90 渭m, was reduced by L-NAME (3 mg 路 kg-1) in the skin of head and gluteal regions and, as indicated by the microsphere content of the lungs, in the total systemic circulation. These results suggest that in the anaesthetized pig (i) NO is involved in the regulation of both systemic and pulmonary vascular conductance, (ii) the decrease in systemic vascular conductance is in part due to constriction of systemic arteriovenous anastomoses, and (iii) the decrease in pulmonary vascular conductance, leading to reduction of cardiac output, seems to negate the expected rise in arterial blood pressure observed, for example, in rats and rabbits following inhibition of NO-synthesis