hypericum and Migraine-Disorders

Migraine is a disabling neurovascular disorder with few targeted, tolerable and effective treatments. Phytomedicines, or plant-based medicinal formulations, hold great promise in the identification of novel therapeutic targets in migraine. Many patients also turn toward herbal and plant-based therapies for the treatment of their migraines as clinical and preclinical evidence of efficacy increases. Patients seek effective and tolerable treatments instead of or in addition to current conventional pharmacologic therapies. We review some phytomedicines potentially useful for migraine treatment-feverfew (Tanacetum parthenium), butterbur (Petasites hybridus), marijuana (Cannabis spp.), Saint John's Wort (Hypericum perforatum) and the Damask rose (Rosa × damascena)-with respect to their mechanisms of action and evidence for treatment of migraine. The evidence for feverfew is mixed; butterbur is effective with potential risks of hepatotoxicity related to preparation; marijuana has not been shown to be effective in migraine treatment, and data are scant; Saint John's Wort shows relevant physiological activity but is a hepatic enzyme inducer and lacks clinical studies for this purpose; the Damask rose when used in topical preparations did not show efficacy in one clinical trial. Other plant preparations have been considered for migraine treatment but most without blinded randomized, placebo-controlled trial evidence.

Topics: Cannabis; Humans; Hypericum; Migraine Disorders; Petasites; Phytotherapy; Plant Preparations; Plants, Medicinal; Tanacetum parthenium

Nurses need to become more aware of serotonin syndrome to avoid its development and to ensure a therapeutic response when early symptoms emerge. While polypharmacy tends to put individuals at greatest risk for the syndrome, use of a single serotonergic agent may also provoke an adverse response. Because the onset and progression of serotonin syndrome are rapid, prompt action may be needed to avoid potentially life-threatening consequences.

Topics: Adult; Antidepressive Agents, Second-Generation; Depressive Disorder; Drug Therapy, Combination; Female; Fluoxetine; Humans; Hypericum; Incidence; Medical History Taking; Migraine Disorders; Nurse's Role; Nursing Assessment; Phototherapy; Primary Prevention; Selective Serotonin Reuptake Inhibitors; Serotonin Receptor Agonists; Serotonin Syndrome; Sumatriptan

Despite a number of antimigraine drugs belonging to different pharmacological classes are available, there is a huge unmet need for better migraine pharmacotherapy. We here demonstrated the capability of Hypericum perforatum, popularly called St. John's wort (SJW), to relieve meningeal nociception in an animal model induced by administration of the nitric oxide (NO) donors glyceryl trinitrate (GTN) and sodium nitroprusside (SNP). GTN and SNP produced a delayed meningeal inflammation, as showed by the upregulation of interleukin (IL)-1β and inducible NO synthase (iNOS), and a prolonged cold allodynia and heat hyperalgesia with a time-course consistent with NO-induced migraine attacks. A single oral administration of a SJW dried extract (5mg/kg p.o.) counteracted the nociceptive behaviour and the overexpression of IL-1β and iNOS. To clarify the cellular pathways involved, the expression of protein kinase C (PKC) and downstream effectors was detected. NO donors increased expression and phosphorylation of PKCγ, PKCɛ and transcription factors, such as nuclear factor (NF)-κB, cyclic AMP response element binding protein (CREB), Signal Transducer and Activator of Transcription (STAT)-1. All these molecular events were prevented by SJW and hypericin, a SJW main component. In conclusion, SJW counteracted the NO donor-induced pain hypersensitivity and meningeal activation by blocking PKC-mediated pathways involving NF-κB, CREB, STAT1. These results might suggest SJW as an innovative and safe perspective for migraine pain.

Topics: Animals; Disease Models, Animal; Drug Evaluation, Preclinical; Hypericum; Male; Meninges; Mice; Migraine Disorders; Nociception; Phytotherapy; Plant Extracts

Despite the substantial improvement that antimigraine drugs brought to migraineurs, there is the need for a long-acting and better tolerated migraine treatment than actual pharmacotherapy. St. John's wort (SJW), a medicinal plant endowed with a favourable tolerability profile, showed numerous bioactivities. We here investigated the pain-relieving property of SJW and its main components, hypericin and flavonoids, in a mouse model induced by nitric oxide (NO) donors administration.. The NO donors nitroglycerin and sodium nitroprusside (SNP) induced allodynia (cold plate test) and hyperalgesia (hot plate test). Western blotting experiments were performed to detect c-Fos and protein kinase C (PKC) expression within periaqueductal grey matter (PAG).. A single oral administration of an SJW dried extract (5 mg/kg p.o.) produced a prolonged relief from pain hypersensitivity. Similarly, preventive SJW administration increased the latency to the induction of hyperalgesia and reduced the duration of the painful symptomatology. Among SJW main components, hypericin showed a similar profile of activity, whereas flavonoids were devoid of any antihyperalgesic effect. To clarify the cellular pathways involved in the SJW mechanism of action, we examined the effects induced by the herbal drug on PKC. NO donors' administration upregulated and increased phosphorylation of PKCγ and PKCε isoforms within PAG that was prevented by SJW treatment. The absence of behavioural side effects or altered animals' locomotor activity by SJW was demonstrated.. These results suggest SJW as a safe therapeutic perspective for migraine pain, and indicate PKC as an innovative target for antimigraine therapy.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Behavior, Animal; Blotting, Western; Cold Temperature; Ergotamine; Hot Temperature; Hyperalgesia; Hypericum; Indomethacin; Injections, Intraventricular; Male; Mice; Migraine Disorders; Motor Activity; Nitric Oxide Donors; Nitroglycerin; Nitroprusside; Pain; Periaqueductal Gray; Plant Extracts; Postural Balance; Protein Kinase C; Vasoconstrictor Agents; Vasodilator Agents

Topics: Body Mass Index; Contraceptives, Oral, Combined; Contraindications; Female; Humans; Hypericum; Migraine Disorders; Plant Preparations

Topics: Adult; Drug Therapy, Combination; Female; Fluoxetine; Humans; Hypericum; Migraine Disorders; Rhabdomyolysis; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome; Tryptamines

Topics: Adult; Drug Therapy, Combination; Female; Fluoxetine; Humans; Hypericum; Migraine Disorders; Rhabdomyolysis; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome; Tryptamines

Topics: Adult; Cyclosporine; Female; Humans; Hypericum; Kidney Transplantation; Migraine Disorders; Patient Compliance; Plants, Medicinal; Postoperative Period