Jorge Luis Ferreiro

Cluster headache attack due to sildenafil intake

Cluster headache (CH) is a distinct, clinical and epidemiological entity. Attacks are stereotypical. Episodes of severe unilateral headache are accompanied by symptoms of autonomic dysfunction. Both aetiology and pathophysiology of CH remain unknown (1). Some types of headache are considered neurovascular diseases. Selective inhibitors of phosphodiesterase (PDEi) have been included in the 2nd edition of the International Classification of Headaches (2) as headache triggers. PDE are enzymes involved in cAMP and cGMP degradation. When they are inhibited, nucleotide levels increase. This is the mechanism used by sildenafil, a highly selective inhibitor of intracellular cGMP degradation (3). Sildenafil and dipiridamol are the best studied PDE5i and both trigger headaches as a secondary effect (3, 4). We now report the first observation, to our knowledge, of isolated attacks of CH after sildenafil administration during the remission period in a patient with a personal history of this particular type of headache.

Sporadic hemiplegic migraine and CREST syndrome

Hemiplegic migraines are characterised by attacks of migraine with aura accompanied by transient motor weakness. There are both familial and sporadic subtypes, which are now recognised as separate entities by the International Classification of Headache Disorders, edition II (ICHD-II). The sporadic subtype has been associated with other medical conditions, particularly rheumatological diseases. We report the case of a woman with sporadic hemiplegic migraine associated with CREST syndrome (calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia). Since there is a close relationship between migraine and Raynaud’s phenomenon, it could be speculated that the sporadic hemiplegic migraines in our patient might be secondary to CREST syndrome.