The authors, in order to evaluate the important role of gastrointestinal dysfunction during the migraine attack, have studied 53 patients with migraine without aura during the asymptomatic stage between attacks. Patients were examined functionally with a pH meter test of the gastroesophageal tract over 24 hours and morphologically with esophagogastroduodenoscopy. The results of this study point out that in a high percentage of patients with migraine, both evaluations are normal. The authors suggest the possibility of detecting, even hypothetically, an alteration of the common neurotransmitter substrate in the origin of migraine attacks and accompanying symptoms.

The authors describe three patients with episodic cluster headache whose attacks were all treated with subcutaneous sumatriptan.The patients described had a high frequency of attacks (more than two per day); therefore, far higher dosage of the drug was taken than commonly used in cluster headache. The patients did not experience any particular side effects, neither during the treatment period nor on abrupt withdrawal of the drug. Moreover, neither tachyphylaxis nor addiction were observed.The authors point out both the efficacy of sumatriptan, confirmed in all the treated attacks, and its safety even at higher dosages than recommended.Key words: episodic cluster headache, sumatriptan, side effects (Headache 1996;36:389-391) The lack of reliable models by which to interpret the different pathophysiologic events underlying migraine and cluster headache makes the definitive pharmacological therapy, either preventive or symptomatic, of these diseases a yet unresolved issue. Sumatriptan, with a chemical structure very similar to serotonin, is a specific and highly selective agonist at 5HT1-like receptors located in the trigeminal nerve endings which are correlated to vascular and meningeal structures sensitive to pain. It is also active on serotonin receptors found on the intracranial blood vessels, thus selectively constricting the major arteries. Sumatriptan's mechanism of action is also believed to implicate an inhibition of the neuropeptide-mediated neurogenic inflammation of the extracranial and meningeal blood vessels. In fact, it seems to inhibit the release of calcitonin gene-related peptide. [1][2][3][4][5][6] The high selectivity of this molecule explains the fact that it does not alter flow resistance of the coronary and peripheral vessels 7 unlike, for example, ergotamine. [8][9] At present, sumatriptan is available in Italy as 100-mg tablets and as preloaded syringes containing 6 mg for subcutaneous administration by an autoinjector device. In other countries, the oral preparation is available as 25-mg and 50-mg tablets.

Migraine with aura and migraine without aura may be different clinical expressions of one disease. This theory is debated, however. In order to further address the issue, we administered a standardized questionnaire to 45 migraineurs. The results indicate a significant overlap between migraine with and without aura, most importantly with respect to response to therapy; 70% of patients had similar responses.

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