Transcranial Doppler ultrasonographic features during drug withdrawal fromdrug-induced headache. A transcranial Doppler follow-up study

Background.-A vascular component in ergotamine-induced headache has been pr oposed. No study has been carried out to evaluate cerebral hemodynamic chan ges by means of transcranial Doppler during withdrawal from migraine medica tion; in particular, ergotamine-containing drugs. Method.-We examined 21 patients suffering from drug-induced headache during their in-hospital withdrawal from ergotamine (n=8) and compared them with patients during withdrawal from analgesics (n=13) and with healthy controls (n=14). Cerebral blood flow velocities were measured with transcranial Dop pler, and pulsatility indices were calculated. Blood pressure, heart rate, and end-tidal carbon dioxide were documented. A subjective analog headache rating scaling was used for day-to-day evaluation of headache severity. Results.-Mean cerebral blood flow velocities dropped significantly after di scontinuation of ergotamine-containing drugs but not after stopping common analgesics. Pulsatility indices remained unchanged. Cerebral blood flow vel ocities were higher in drug-ingesting patients compared to the control grou p and showed significant changes in patients with headache using ergotamine and in those using analgesics. Carbon dioxide, heart rate, and blood press ure remained unchanged. The headache rating scale did not show a constant t rend. Comments.-Our results indicate that ergotamine and, to a lesser extent, com mon analgesics including caffeine might influence cerebral blood flow veloc ities and pulsatility indices causing transient and reversible disturbance of cerebral autoregulation.