Prostaglandin E2 induces immediate migraine-like attack in migraine patients without aura

Background: Prostaglandin E 2 (PGE 2 ) has been suggested to play an important role in the pathogenesis of migraine. In the present experiment we investigated if an intravenous infusion of PGE 2 would induce migraine-like attacks in patients with migraine. Methods: Twelve patients with migraine without aura were randomly allocated to receive 0.4 µg/kg/min PGE 2 (Prostin®E2, dinoprostone) or placebo over 25 minutes in a two-way, crossover study. Headache intensity was recorded on a verbal rating scale, middle cerebral artery blood flow velocity (V MCA ) was measured by transcranial Doppler (TCD) and diameter of the superficial temporal artery (STA) was obtained by c-series scan (Dermascan C). Results: In total, nine migraine patients (75%) experienced migraine-like attacks after PGE 2 compared to none after placebo ( p = 0.004). Seven out of 9 (58%) patients reported the migraine-like attacks during the immediate phase (0–90 min) ( p = 0.016). Only two patients experienced the delayed migraine-like attacks several hours after the PGE 2 infusion stop ( p = 0.500). The V MCA decreased during the PGE 2 infusion ( p = 0.005) but there was no significant dilatation of the STA ( p = 0.850). Conclusion: The migraine-like attacks during, and immediately after, the PGE 2 infusion contrast with those found in previous provocation studies, in which the other pharmacological compounds triggered the delayed migraine-like attacks several hours after the infusion. We suggest that PGE 2 may be one of the important final products involved in the generation of migraine attacks.