Khalid Farooq Danish, Abdur Rashid Chaudhry, Shah Sattar Khan.
Intractable headache as a side effect of topical nitroglycerin ointment.
Rawal Med J Jan ;33(1):15-7.

Objective: To determine the pattern of severe intractable headache with the use of topical Glyceryl Trinitrate (GTN) cream for treatment of fissure in ano, necessitating stoppage of treatment. Methods: The Cross sectional, descriptive, quasi-experimental study was conducted on fifty patients with acute fissure in ano, presenting in surgical OPD of Islamic International Medical College (IIMC) Trust Railway General Hospital, Maryam Memorial Hospital, and Burhani Medical Center, Rawalpindi. The diagnosis was based on clinical history and examination findings. GTN 0.2% ointment was used topically, in a quantity of 1-2 ml 8 hourly for initial ten days. No concomitant analgesic therapy was advised. Ispagula husk 2 tablespoonfuls at bedtime was prescribed to all patients. Incidence of headache and its severity was assessed using verbal descriptor pain scale, rating the severity of pain from 0-10. A score of 0-3 was interpreted as mild, 4-7 as moderate and 8-10 as severe pain. Results: Out of 50 patients, four (8%) complained of severe headache. In three (6%) patients the treatment had to be abandoned. Thirteen (26%) patients had a disturbance of daily routines due to headache; however, therapy could still be continued. Conclusions: Headache is common, and only occasionally is severe enough to compel the patient to discontinue treatment. The treatment has the advantages of ease, recurrent use and cost-effectiveness. (Rawal Med J 2008;33:15-17).

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com