Ot due to other causes but may be the illness per se) or secondary (i.e., the symptom of one more situation)2. In 80 of cases, the chronic headache is really a secondary effect caused by an excessive intake of drugs, mainly analgesics3. The excessive intake of pain-killers for greater than consecutive three months may cause medication overuse headache (MOH), a secondary kind of chronic headache, widespread among migraineurs2. Right here we report the case of a patient struggling with a chronic headache associated to the overuse of naphazoline nitrate, an over the counter nasal decongestant that the patient spontaneously utilized to treat a self diagnosed chronic sinusitis.The chronic headache disappeared following the remedy suggested by otolaryngologist. Immediately after 3 months of headache diary recording and clinical re-evaluation, the clinical picture was significantly changed: patient presented only sporadic attacks of migraine devoid of aura (ICHD-II 1.1). By an anamnesis re-evaluation it emerged that an episodic headache arose in childhood and worsen more than the years, until it became chronic by the age of 18. One particular year soon after naphazoline detoxification, the patient has suffered from a couple of attacks during the year, treated with triptans.DiscussionThe case we report is suggestive for any chronic headache secondary to naphazoline nitrate overuse, considering the fact that drug discontinuation interrupted the clinical symptoms. It truly is not clear however, no matter if the improvement in the chronic headache was due to a well-known naphazoline nitrate adverse occasion (AE) of inducing headache4, or no matter whether it was due to a MOH-like occurance, because the patient consumed this drug to treat his headache. Certainly, patient skilled a relief on his headache by naphazoline, this was the reason he supposed, erroneously, to suffer of chronic sinusitis. The anti-migraine effect of naphazoline on our patient raises a query: is it correct to regard naphazoline as a migraine medication Naphazoline can be a sympathomimetic drug, an imidazolinic derivate with marked alpha-adrenergic activity4.Linperlisib Formula It enhances the release of noradrenaline from adrenergic termination, instantly relieving the nasal congestion thanks to its vasoconstricting action on the vessels of nasal mucosa5.Purmorphamine custom synthesis For the reason that of its adrenergic activity, this drug can also create adverse effects, like rhinitis medicamentosa, hypertension, headache and acute depression of central nervous technique with marked sedation4.PMID:23991096 Furthermore, situations of ischemic and hemorrhagic stroke secondary to naphazoline have also been reported, mediated by the alpha1 and alpha2 adrenergic vasoconstrictive effect that is definitely also exerted on brain vessels6,7. Naphazoline can trigger headaches because of its adrenergic activity (Figure 1). Alpha1 receptors are connected with G-proteins that create a cascade of events top for the production of arachidonic acid (AA) and nitric oxide (NO). AA and NO release results in a late inflammatory vasodilatation8,9 that could induce a migraine attack10. Additionally, it is also probable that the exact same naphazoline nitrate, consumed by our patient, could have contributed towards the production and release of additional NO by a chemical reduction in the naphazoline salt. In truth, NO donors are currently used to induce migraine attacks in clinical and experimental settings11. Nonetheless, in spite of the late impact as a migraine trigger issue, naphazoline could possibly also have an early action as an anti-migraine agent acting on alpha receptors of muscle, immune cells, Locus Coeruleus and spina.