Migraine headache is a recurrent throbbing headache that typically affects one side of the head and is often accompanied by nausea and disturbed vision. It involves nausea, vomiting, visual scotomas (a scotoma is an aura/blind spot that obstructs part of one’s vision) or even hemianopsia (occurs when one loses sight in half of his/her visual field), and speech abnormalities. Migraine is basically a brain disorder involving an ion channel in the aminergic brainstem nuclei which gives rise to vasodilation, eventually causing migraine headaches.

Triptans are considered the most effective treatment for migraine headaches. These drugs stimulate/activate the serotonin receptors. When activated, the receptors reduce inflammation and promotes vasoconstriction, thereby stopping or reducing the severity of migraine headaches .

The ergot alkaloids, and antidepressants function like triptans in activating serotonin 1D/1B receptors on presynaptic trigeminal nerve endings to inhibit the release of vasodilating peptides, and antiseizure agents work by suppressing excessive firing of these nerve endings. As mentioned above, it is the vasoconstrictor actions of direct serotonin agonists (the triptans and ergot) that prevent vasodilation and stretching of the pain endings.

Sumatriptan and other triptans are selective agonists for serotonin 1D and serotonin 1B receptors. They are the first line of drug treatment for acute severe migraine attacks. They are however contraindicated in patients with or at risk of coronary artery disease or/and angina, this is due to the drugs vasoconstrictor actions.

Anti-inflammatory analgesics (such as ibuprofen and aspirin) help with controlling the pain or migraine. Parenteral metoclopramides are helpful in controlling the severe pain and vomiting.

Adverse effects of sumatriptan include (ranging from mild to severe):

• • Altered sensations
• • Dizziness
• • Muscle weakness
• • Neck pain
• • For parenteral sumatriptan, injection site reaction.

As effective as sumatriptan is (including other triptans, such as almotriptan, sumatriptan, rizatriptan, and zolmitriptan) it has a duration of action shorter than the duration of the migraine headache, therefore several doses may be required during a prolonged migraine attack, but the adverse effects limit the maximum safe daily dosage.

Other triptans are contraindicated in contraindicated in patients with severe hepatic or renal impairment or peripheral vascular syndromes (Naratriptan and eletriptan). For frovatriptan, it is contraindicated in patients with peripheral vascular disease and zolmitriptan in patients with Wolff-Parkinson-White syndrome (a syndrome in which an extra electrical pathway in the heart causes a rapid heartbeat).

Drug treatment used for prophylaxis of migraine headaches:

• • Propranolol, amitriptyline, and some calcium channel blockers, but have no value in the treatment of acute migraine.
• • Anticonvulsants valproic acid and topiramate.
• • Flunarizine a calcium channel blocker which reduces the severity of the acute attack and to prevent recurrences.
• • Verapamil which is considered to have modest efficacy as prophylaxis against migraine