Updated: 11/1/2016


Review Topic
  • A 26-year-old female presents for the evaluation of her headache. Her headache began yesterday, and is on the left side of her skull. It is of throbbing quality, and does not radiate. The pain worsens with physical activity. She reports that sitting in a quiet, dark room helps with her symptoms. She has tried over-the-counter non-steroidal anti-inflammatory (NSAID) medication, which provided no relief. She was then prescribed a medication that she could use as an abortive therapy.
  • Etiology of migraine headache is not fully understood
  • Data suggests that it may be due primary dysfunction of neurons that leads to headache presentation.
    • serotonin is involved in the pathophysiology of migraine headaches
  • Serotonin and migraine headache
    • serotonin’s role in migraine generation is not well understood.
      • maybe due to action on cranial vasculature
      • maybe due to involvement in central pain pathways
  • Mechanism 5-HT1B/1D agonist
    • promotes vasoconstriction
    • inhibits vasoactive peptide release
    • inhibits brainstem pain pathways
    • inhibition of trigeminal nerve activation
      • perhaps secondary to calcitonin gene related peptide (CGRP) level reduction
  • Clinical use
    • migraine headache
      • involved in the abortive therapy of migraine headaches
      • ergotamine can be used as an alternative
    • cluster headache
      • considered first-line in the treatment of acute cluster headaches
      • 100% oxygen is also considered first-line
  • Toxicity
    • coronary vasospasm
      • contraindicated in patients with CAD or Prinzmetal's angina

-          Inhibit vasoactive peptide release

-          Promotes vasoconstriction

-          Inhibits brainstem pain pathways

-          Inhibition of afferent input into the trigeminal nucleus caudalis

o   Perhaps secondary to calcitonin gene related peptide (CGRP) level reduction.

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