As per the outcomes of a recent case-control study issued in PAIN journal, glyceryl trinitrate (GTN) stimulated the naturally occurring premonitory symptoms and portrayed that yawning, nausea, photophobia, and concentration complications are most specific for a forthcoming GTN-prompted migraine-like headache.

Unprompted and pharmacologically provoked migraine attacks are commonly headed by non-headache symptoms known as the premonitory symptoms. Onderwater, Gerrit L.J. et al. systematically assessed premonitory symptoms in patients suffering from migraine and healthy controls after the use of GTN. A semistructured interview evaluating 21 promising premonitory symptoms every 15 minutes in the 5 hours after GTN infusion (0.5 µg/kg/min in 20 minutes) was performed in 34 females with migraine without aura and 24 age-matched female controls.

As found, migraine-like headaches arose in 28 out of 34 (82.4%) migraineurs i.e. the GTN responders. 

Following GTN use, 26/28 (92.9%) responders, 6/6 (100%) nonresponders, and 13/24 (54.2%) controls described at least 1 promising premonitory symptom, refer to the table below:

Table: Non-headache symptoms described following the initiation of GTN infusion.

The migraineurs who developed a migraine-like attack commonly reported concentration issues, yawning, nausea, and photophobia as compared to healthy controls. Of particular interest, concentration issues were exclusively described by those who had a migraine-like attack.