[Pitfall in migraine treatment].
Migraine is a very common disorder. In Japan, an estimated 8.4% of population experience migraine, but most of them go undiagnosed and undertreated. Recent advances in basic and applied clinical neuroscience have led to the development of sumatriptan, a new class of selective serotonin (5-hydroxytryptamine (5-HT)) receptor agonists that activate 5-HT 1B/1D receptors. Following sumatriptan several other triptans were produced. They have three main mechanism of action: cranial vasoconstriction, peripheral trigeminal inhibition, and inhibition of transmission through second order neurons of the trigeminocervical complex. Even in our country, we can now use three kinds of triptans, which are very effective medicine against acute migraine with a well-developed scientific rationale. Despite the higher price, triptans were preferred over ergots in most patients. Recently Limmroth et al reported a prospective study for medication overuse headache (MOH) in 98 patients. The mean critical duration until onset of MOH was shortest for triptans (1.7 years), longer for ergots (2.7 years), and longest for analgesics (4.8 years). The mean critical monthly intake frequencies was lowest for triptans (18 single doses per month), higher for ergots (37), and highest for analgesics (114). We should keep in mind that overuse of triptans leads to MOH faster and with lower dosages compared with ergots and analgesics.
Araki
Nobuo
N
Department of Neurology, Saitama Medical School.
D000075202:Contraindications; D020773:Headache Disorders / Q000139:chemically induced; D006801:Humans; D015201:Meta-Analysis as Topic; D008881:Migraine Disorders / Q000188:drug therapy* / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D017366:Serotonin Receptor Agonists / Q000009:adverse effects / Q000627:therapeutic use; D018170:Sumatriptan / Q000009:adverse effects / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use
D017366:Serotonin Receptor Agonists; D014662:Vasoconstrictor Agents; D018170:Sumatriptan