Migraine involves the trigeminal nerve distribution to intracranial arteries. These nerves release neurotransmitters like calcitonin (a vasodilator). The vasodilation and stretching caused by perivascular edema may be the cause of migraine. Relieve of a migraine can be by therapy of diminution of these pulsations.
Sumatriptan is first in line to treat acute severe migraine, because it’s a generic and much cheaper than the other -triphans, and should not be used in patients with coronary artery disease because it can cause discomfort and pain in chest. Anti-inflammatory anagelsics such as Aspirin and Ibuprofen can also be used. For patients with severe nausea and vomiting, can parenteral Metoclopramide be used. Almotriptan, Rizatriptan and Zolmitriptan can also be used but they do have a short duration of effect. Naratriptan and Eletriptan, Frovatriptan and Zolmitriptan can also be used but have some contraindications.
Lasmiditan is also used for antimigraine. It has the affinity for 5-HT receptors, it does not cause vasoconstriction and is thus safer than triptans regarding cardiovascular system. It reduces trigeminal nerve stimulation-induces plasma and plasma protein extravasation in dural vessels. Erenumab and Ubrogepant binds to CGRP receptors and prevents activation by peptides, and treat acute migraine attacks. Propanalol, Amitriptyline and some Ca²⁺ blockers can also be used in migraines. Flunarizine (Ca²⁺ blocker) reduce the severity of an acute attack. Verapamil have also been effective.