Dopamine and migraine: a review of pharmacological, biochemical, neurophysiological, and therapeutic data.
The dopamine theory of migraine pathogenesis, first proposed by F. Sicuteri in 1977, has attracted renewed interest after an increased frequency of the dopamine D2 receptor (DRD2) gene allele NcoI C was found in patients with migraine with aura. Therefore we reviewed the relevant literature. The most compelling argument favoring an interictal hypersensitivity of dopamine receptors in migraineurs stems from pharmacologic studies of the gastric and autonomic effects of dopaminergic agents such as apomorphine, but none of these studies was blinded and placebo-controlled. Various DRD2 antagonists abort migraine attacks after parenteral administration, while there is circumstantial evidence that dopamine agonists may be useful for prophylaxis. Most drugs used in these trials, however, lack selectivity for dopamine receptors. Both in pharmacological and therapeutic studies most patients had migraine without aura. We conclude that data suggesting a primary role for the dopaminergic system in migraine pathogenesis are unconvincing. Based on well established interactions between central amines, a reduced release of serotonin between attacks could lower dopamine release which would lead to receptor hypersensitivity.
Mascia
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A
Department of Neurology, CHR Citadelle, University of Liège, Belgium.
Afra
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J
Schoenen
J
J
D001921:Brain / Q000187:drug effects / Q000503:physiopathology; D002986:Clinical Trials as Topic; D004298:Dopamine / Q000502:physiology*; D018491:Dopamine Agonists / Q000627:therapeutic use; D018492:Dopamine Antagonists / Q000627:therapeutic use; D065127:Dopamine D2 Receptor Antagonists; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy / Q000503:physiopathology*; D017448:Receptors, Dopamine D2 / Q000502:physiology
D018491:Dopamine Agonists; D018492:Dopamine Antagonists; D065127:Dopamine D2 Receptor Antagonists; D017448:Receptors, Dopamine D2; D004298:Dopamine