New Treatments for Migraine

Sumatriptan (Imitrex) a 5-hydroxytryptamine (5-HT)10 receptor agonist. Has selective vasoconstrictor effect on blood vessels especially the internal carotid and middle cerebral. Does NOT readily penetrate the blood-brain barrier. It is well absorbed orally and subcutaneously but the bioavailability of oral sumatriptan is only 14% compared to 96% when given subcutaneously. Adverse effects are tingling, dizziness, warmihot sensation, neck pain and stiffness and injection site reactions. Chest symptoms of uncertain cause occur in 3-5%. Of the more than 3 million migraine attacks treated with sumatriptan to date, only 4 cases of myocardial ischemia with coronary vasospasm have been documented. The drug should not be used in any patient with a history of myocardial infarction, symptomatic ischemic heart disease, Prinzmetal's angina or hypertension. Sumatriptan is the most extensively studied recent drug for migraines.