What are the other Names for this Condition? (Also known as/Synonyms)

• Dynamite Headache
• Hot Dog Headache
• NO Donor-Induced Headache

What is Nitric Oxide Donor-Induced Headache? (Definition/Background Information)

• Nitric Oxide (NO) Donor-Induced Headache is described as a form of headache that occurs secondary to the use of nitric oxide donor medications. The onset of the headache may be immediate or after a short interval of time following exposure to the medication
• Based on the time duration of development of the headache, there are two forms of NO Donor-Induced Headaches, namely:
  • Immediate NO Donor-Induced Headache
  • Delayed NO Donor-Induced Headache
• Nitric oxide donors form a group of medications that are used in the treatment of a wide variety of diseases and conditions, including certain cancers. Some of the drugs include amyl nitrate, glyceryl trinitrate (GTN), mannitol hexanitrate, pentaerythrityl tetranitrate, and sodium nitroprusside
• It is reported that the type of headache caused by nitric oxide donor medications, normally as a side effect, are often of the pulsating type, involving the front and sides of the head
• Individuals with a history of migraines or tension-type headaches have a higher risk for Nitric Oxide Donor-Induced Headaches

The criteria for diagnosis of Nitric Oxide (NO) Donor-Induced Headache as outlined by the International Headache Society (IHS) is given below:

• Use of, or exposure to nitric oxide donor medications
• Headache fulfilling all the criterion below
• Evidence of causation demonstrated by at least two of the following:
  • Headache has developed in temporal relation to use of, or exposure to nitric oxide donor medications
  • Headache has significantly improved or resolved in close temporal relation to cessation of use of, or exposure to nitric oxide donor medications
  • Headache has characteristics typical for use of, exposure to nitric oxide donor medications
  • Other evidence exists of causation
• Not better accounted for by another ICHD-3 diagnosis

In addition to satisfying all of the above, the specific criteria (below) for immediate or delayed subtypes of NO donor headache must be satisfied.

For Immediate NO Donor-Induced Headache, evidence of causation demonstrated by all of the following:

• Headache has developed within 1 hour after absorption of the NO donor
• Headache has resolved within 1 hour after release of NO has ended
• Headache has at least one of the following four characteristics:
  • Bilateral
  • Mild to moderate intensity
  • Pulsating quality
  • Aggravated by physical activity

For Delayed NO Donor-Induced Headache, evidence of causation demonstrated by all of the following:

• Headache has developed within 2-12 hours after exposure to the NO donor, and after NO is cleared from the blood
• Headache has resolved within 72 hours after exposure

(Source: International Headache Society Classification ICHD-3, London, United Kingdom)