Authors: Jerome H Check, Diane L Check, Brooke Neumann.
One of the hypothesized mechanisms for headaches is an increase in brain tissue permeability resulting in unwanted irritants permeating brain tissue leading to inflammation and pain. Support for this hypothesis was provided by the demonstration that treatment with the drug dextroamphetamine sulfate leads to very improved relief of pain even when standard treatments have failed. The reason for using dextroamphetamine sulfate was to release more dopamine from sympathetic nerve fibers to decrease cellular permeability, and thus inhibit infiltration of irritants. However, it is possible that this sympathomimetic amine functions in some different way to relieve headache pain other than diminishing cellular permeability by releasing dopamine. To test this hypothesis another drug, cabergoline, which is not in the amphetamine class of drugs, that releases more dopamine into the circulation, was given to a woman with severe headaches refractory to all standard therapy with the exception of dextroamphetamine sulfate. Similar to dextroamphetamine sulfate, cabergoline resulted in marked amelioration of the headaches thus supporting the hypothesized mechanism. From a practical standpoint, cabergoline can be tried in patients who have side effects from dextroamphetamine sulfate. Also, since cabergoline has no class II drug restrictions, patients and prescribing physicians may be more comfortable prescribing cabergoline over dextroamphetamine sulfate. Furthermore, it can substitute as an alternate treatment for patients in certain states, e.g., New Jersey, where off-label use of class II drugs is prohibited.
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