Ultracet (Acetaminophen, Tramadol)
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PLATELETS IN MIGRAINE
During a migraine attack, the lessening of blood flow may not be entirely due to narrowing of the blood vessels since the blood itself may become more sticky and liable to sludge. Platelets are constituents of blood that have the ability to stick together and form clumps, an essential first stage in the familiar clotting reaction which plugs the gap in a cut vessel and stops bleeding. Occasionally these clumps can produce disease, as in certain forms of stroke, when they pass through the circulation to the brain and cause loss of function. This is not to say that an attack of migraine is like a stroke, but there are certain similarities as far as platelets are concerned. The platelets of migraine sufferers clump together more easily than those of other people. But since many factors can alter platelet aggregation, this finding might be a secondary effect of the migraine attack. It is possible to measure the aggregation of platelets, either by the response to certain chemicals or by measuring the proportion of clumped platelets in a blood sample. These techniques have been used in migraine patients and it was found that some patients have an increased number of clumped platelets; this is present all the time but becomes worse during a migraine attack. This suggests that platelets in migraine subjects are on ‘red alert’, awaiting only the slightest stimulus to clump together. This abnormality has also been found in relatives of migraine sufferers. Research is now being directed at the alteration of platelet function in the hope that this might eventually be used to prevent migraine attacks.
What makes platelets clump together? Various chemicals can do this, for example substances such as collagen found within blood vessel walls, and vaso-active amines such as adrenalin, noradrenalin, histamine, and serotonin (5HT). But the most potent platelet aggregators are substances called prostaglandins. Discovered about 15 years .ago, they have marked effects on blood vessels and smooth muscle as well as participating in the inflammatory reaction. One of their actions is involved in the contraction of the uterus during labour. Until recently, only the stable members of this family could be studied, but a substance has just been found which lasts only about half a minute and which has a powerful effect on platelets. It is produced by platelets themselves and, when platelets stick together, a sort of cascade process occurs, each platelet producing more of this substance.
Interestingly, the vessel wall itself produces a substance with the opposite effect. This substance, prostacyclin or PGX, in addition to preventing platelets from aggregating, also has a marked action on vessel walls, causing them to dilate. These findings are exciting in their potential but are too recent to have been fully studied in connection with migraine.
When platelets clump together, they produce serotonin, or 5-hydroxytryptamine (5HT), which has a marked constricting effect on blood vessels. During attacks of migraine the amount of 5HT in the platelet clump decreases, while the excretion of the breakdown products of 5HT increases. Experiments suggest that under certain circumstances, 5HT can cause both dilatation of the extracranial carotid artery and constriction of the intracranial carotid artery.
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