Summary:Migraine is a debilitating disorder of the CNS. Although therapeutic options for migraine attacks have tremendously advanced with the development of triptans more than a decade ago, several conditions (such as vascular disease) restrict their use. Moreover, some patients do not respond to triptans and other currently available medications. Therefore, treatment alternatives are needed. Study data show that 5-HT 1F receptor agonists successfully abort migraine attacks. These data also suggest a favorable vascular side-effect profile of these substances, which could be beneficial for migraine treatment in subjects with cardiac or vascular disease. We discuss the current knowledge of 5-HT 1F receptor-mediated effects, in part by comparing them to triptans, and we also summarize data from basic research and clinical trials. Key Words: 5-HT 1F , serotonin receptor, migraine, treatment, triptans.
CURRENT TREATMENT OPTIONSMigraine attacks can be treated effectively with nonsteroidal anti-inflammatory drugs, pain killers, the first generation triptan (sumatriptan), and newer triptans such as rizatriptan or almotriptan. To date, these 5-HT 1B/1D agonists represent the gold standard for the treatment of migraine attacks. A meta-analysis showed that 59% of all patients achieve a headache response with 100 mg sumatriptan orally. Approximately 29% of subjects are pain-free after 2 h, and 20% of subjects show sustained pain freedom (pain-free by 2 h after dosing and no headache recurrence or use of rescue medication through 24 h). With some of the newer triptans, higher success rates of as much as 40% for the 2 h pain-free endpoint can be seen.1 Despite the good efficacy of triptans, it has been estimated that approximately 25% of all migraine patients do not respond to triptan treatment, even when the drug is used correctly (i.e, according to prescribed dose, time, and route of administration).2 The reasons for treatment failure remain obscure.Triptans are supposed to have three important mechanisms of action: 1) vasoconstriction, 2) inhibition of neuropeptide release, and 3) inhibition of signal transmission to second order neurons within the trigeminal nucleus complex. 3 The inhibition of calcitonin generelated peptide and substance P release attenuates peripheral consequences of trigeminal stimulation (e.g., neurogenic inflammation) and also central pain transmission. However, it is still an unsolved question as to whether neuronal or vascular or both mechanisms are responsible for the anti-migraine effect of these compounds.
5-HT 1 RECEPTORS AND MIGRAINETriptans exert their function mainly through binding at the 5-HT 1B and 5-HT 1D receptor. The 5-HT 1B receptor can be found on smooth muscle cells in cerebral and coronary vessels, and this receptor mediates triptan induced vasoconstriction.4 -8 Experimentally, various isolated blood vessels from several species contract in response to triptans. The vascular effects of 5-HT 1B/1D agonists are more pronounced in cranial vessels than in peripheral arteries, probably ...