Clinical Observations on the Mechanism of Hypertensive Headache and the Results of its Treatment with Dihydroergotamine Tartrate
ROBERT BIRCHALL, M.D.
ROBERT D. TAYLOR, M.D.
IRVINE H. PAGE, M.D.
Suggestive evidence indicates that hypertensive headaches are in some respects similar to migraine (Janeway1) and may be due to dilatation and distention of branches of the external carotid rather than intracranial arteries (Schumacher and Wolff2). As reported by Steiner,3 migraine can often be relieved by vasoconstriction and the resultant decreased amplitude of arterial pulsation induced by ergotamine tartrate. However, this drug is not without unpleasant side effects such as nausea and vomiting. Although it has also been shown to elevate the blood pressure of human beings, the elevation is not of great magnitude, since Pool, von Storch, and Lennox4 showed that subjects who were given injections of 0.5 mg. intravenously had an average rise of only 13 mm. Hg in both systolic and diastolic pressure.
Recently, dihydroergotamine tartrate has been made available for clinical trial and is believed to be less toxic than the parent drug. The Cleveland Clinic Research Division tested its value in the control of headache associated with hypertension by giving doses of 1 mg. by subcutaneous injections to 13 patients who exhibited headache. A total of forty such injections was administered. To determine the effect of dihydroergotamine tartrate upon blood pressure 1 mg. was given by subcutaneous injection to 5 hypertensive persons. The blood pressure was measured every fifteen minutes for two hours.
In order to explore further the similarity of hypertensive headache to migraine headache, the effects of pressure on the external carotid artery and its palpable branches were tested in 6 patients with headache. . .