In the present study, 23 patients with migraine without aura were monitored during a migraine attack. Plasma levels of interleukin (IL)-4, IL-5, IL-10, and interferon-gamma were measured by enzyme-linked immunosorbent assay techniques. Interestingly, we observed low to undetectable IL-5 and IL-4 levels, whereas high IL-10 levels were seen in 52.2% of the patients. Interferon-gamma plasma levels were undetectable in all patients. After treatment with sumatriptan, 10 patients showed a subsequent decrease in IL-10 and an increase in both IL-4 and IL-5 plasma levels. Although these findings are derived from a limited number of patients, the apparent return to the IL-4 and IL-5 cytokine profile observed during the interictal period leads us to speculate that a preferential enhancement of TH2-type cytokine production may contribute to the pathogenesis of migraine.

Thirty-two patients suffering from migraine without aura were assessed during in interictal period to evaluate the contribution of cytokines to the pathophysiology of migraine. To this end, plasma levels of IFN-gamma, IL-4, IL-5, and IL-10 were measured by enzyme-linked immunosorbent assay (ELISA) techniques. Plasma levels of both IFN-gamma and IL-10 were not increased in the patients and did not differ significantly from healthy controls. Of interest, we observed a strong increase of IL-5 levels in 84.3% as well as increased IL-4 levels in 37.5% of patients with migraine without aura. These results suggests a preferential enhancement of some Th2-type cytokines, and may support the growing arguments of an immunoallergic mechanism in the pathophysiology of migraine.

Aim of this study is to evaluate if migraine, daily chronic headache and fibromyalgia in the same patient can be considered as an evolutive continuum of non organic chronic pain. Therefore, migraine, daily chronic headache and fibromyalgia should be considered the expression of chronic antinociceptive system alteration.

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.