SEROTONIN 1D (5-HT1D) AGONISTS AND OTHER AGENTS IN ACUTE MIGRAINE
1997; Elsevier BV; Volume: 15; Issue: 1 Linguagem: Inglês
10.1016/s0733-8619(05)70295-4
ISSN1557-9875
Autores Tópico(s)Cardiovascular Syncope and Autonomic Disorders
ResumoSerotonin (5-HT), specifically 5-HT1D, receptor agonists are the most specific antimigraine agents available. The trigeminal vascular system is activated during a migraine attack, resulting in vasodilation and perivascular neurogenic inflammation.13, 14, 24, 36, 48, 81, 82 5HT1D agonists cause vasoconstriction, reduce neurogenic inflammation, and may reduce pain transmission through the trigeminal system.13, 14, 24, 36, 48, 81, 82 In addition, certain agents, such as dihydroergotamine (DHE) and zolmitriptan (311C90) may exert central action. Available 5-HT1D agonists include Sumatriptan DHE Ergotamine DHE and ergotamine have wider spectrum of receptor affinity. 5-HT1D agonists currently under clinical trial include Zolmitriptan (ZOMIG) Naratriptan Rizitriptan Alniditan Eletriptan SB 209509 (VML 251) Factors that determine the choice of medications for treating the acute attacks of migraine include Time to peak Severity Associated symptoms, particularly nausea and vomiting Disability caused by the attack Frequency of attacks Time to peak (time taken to reach the maximum intensity) is an important consideration. Table 1 shows suggested options for selection medication based on time to peak. Simple analgesics and nonsteroidal inflammatory agents play an important role in the treatment of mild to moderate attacks of migraine. The present discussion will not include them. Because ergotamine has been in use for a long time and widely written up, there will be no detailed discussion on it.
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