Headache epoprostenol

Beraprost, an epoprostenol (PGI2) analogue, has been studied in intermittent claudication. Adverse events include gastrointestinal disorders, headaches, skin disorders, and fever (30). 

Side effects, such as headache and jaw pain, are observed, but the major drawbacks with epoprostenol therapy relate to its delivery. Epoprostenol has an extremely short half-life in the blood (2-3 min) and therefore must be administered by continuous intravenous infusion via a surgically implanted central vein catheter. This can lead to complications such as local infections, sepsis, or catheter-associated thrombosis. In addition, interruption of therapy due, for example, to pump failure can lead to a life-threatening rebound of symptoms. The compound itself is unstable at room temperature and must be stored in the refrigerator. Despite these severe drawbacks, i.v. epoprosenol remains a useful treatment for patients presenting with WHO class IV PAH. The problems with epoprostenol have led to the development of alternative agents. 

PGI 2 (Epoprostenol) Inhibits platelet aggregation. Reduce incidence of thrombus formation. Also used in angina, pulmonary hypertension, and Raynaud s phenomenon. Headache, nausea, vomiting, anxiety, Gl upset. 

Nervous system The headache eliciting effect of prostacyclin (PGI2) has been studied in 12 healthy subjects in a double-blind, crossover, study [30, in which epoprostenol 10 nanograms/kg/minute was infused for 25 minutes. During the immediate phase (0-30 minutes) and the post-infusion phase (30-90 minutes) 11 subjects reported headache after epoprostenol and none reported headache on the placebo day. The headache was associated with dilatation of the superficial temporal artery but there was no dilatation of the middle cerebral artery. These data suggest that PGl2-induced headache may be due to activation and sensitization of sensory afferents around extracranial arteries. 

Wienecke T, Olesen J, Oturai PS, Ashina M. Prostacyclin (epoprostenol) induces headache in healthy subjects. Pain 2008 139(1) 106-16. 

---