Abstract
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 costeffectiveness.
(Rawal Med J 2008;33:15-17).

Key words: Anal fissure, topical nitroglycerin, intractable headache.