Subcutaneous Sumatriptan for Refractory Trigeminal Neuralgia

Kanai, Akifumi; Saito, Miwako; Hoka, Sumio

doi:10.1111/j.1526-4610.2006.00405.x

Cited by 62 publications

(52 citation statements)

References 19 publications

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“…Another two small RCTs with tizanidine showed this drug to have results similar to carbamazepine [58,59]. A recent novel approach is subcutaneous sumatriptan [60]. The premise was that there might be a role for a 5-HT receptor in trigeminal neuralgia.…”

Section: Oxcarbazepinementioning

confidence: 99%

Medical management of trigeminal neuropathic pains

Zakrzewska

2010

Expert Opinion on Pharmacotherapy

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Section: Oxcarbazepinementioning

confidence: 99%

Medical management of trigeminal neuropathic pains

Zakrzewska

2010

Expert Opinion on Pharmacotherapy

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“…The monoamine neurotransmitter serotonin (5HT) has been implicated in several pain conditions mediated by the trigeminal system [20; 22; 30; 32]. Several therapeutics being examined in clinical trials predominately target the central serotonergic system to treat migraine [13; 24] and trigeminal neuropathy [36]. As 5HT is pronociceptive in the peripheral nervous system where pain is often initiated, it may be effective to target the peripheral serotonergic system as a therapeutic option.…”

Section: Introductionmentioning

confidence: 99%

Serotonin increases the functional activity of capsaicin-sensitive rat trigeminal nociceptors via peripheral serotonin receptors

Loyd

Weiss

Henry

et al. 2011

Pain

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Peripheral serotonin (5HT) has been implicated in migraine and temporomandibular pain disorders in humans and animal models and yet the mechanism(s) by which 5HT evokes pain remains unclear. Trigeminal pain can be triggered by activation of the transient receptor potential V1 channel (TRPV1), expressed by a subset of nociceptive trigeminal ganglia (TG) neurons and gated by capsaicin, noxious heat, and other noxious stimuli. As 5HT is released in the periphery during inflammation and evokes thermal hyperalgesia and TRPV1 is essential for thermal hyperalgesia, we hypothesized that 5HT increases the activity of capsaicin-sensitive trigeminal neurons and that this increase can be attenuated by pharmacologically targeting peripheral 5HT receptors. TG cultures were pretreated with 5HT (10 nM–100 µM), sumatriptan (5HT1B/1D agonist), ketanserin (5HT2A antagonist), granisetron (5HT3 antagonist) or vehicle prior to capsaicin (30 nM – 50 nM). Single-cell accumulation of intracellular calcium was recorded or CGRP release was measured following each treatment. In addition, using in situ hybridization and immunohistochemistry, we detected the co-localization of 5HT1B, 5HT1D, 5HT2A and 5HT3A, but not 5HT2C, mRNA with TRPV1 in TG cells. 5HT pretreatment evoked a significant increase in calcium accumulation in capsaicin-sensitive trigeminal neurons and enhanced capsaicin-evoked CGRP release, but had no significant effect when given alone. Sumatriptan, ketanserin and granisetron treatment attenuated calcium accumulation and 5HT enhancement of capsaicin-evoked CGRP release. Together these results indicate that 5HT increases the activity of capsaicin-sensitive peripheral nociceptors, which can be attenuated by pharmacologically targeting peripheral 5HT receptors, thereby providing a mechanistic basis for peripheral craniofacial pain therapy.

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“…The cause of trigeminal neuralgia is not fully understood. It is thought to be due to irritation or compression of the trigeminal nerve root by neighbouring arteries [6]. This is the basis for neurosurgical decompression procedures.…”

Section: Discussionmentioning

confidence: 99%

Treatment resistant trigeminal neuralgia relieved with oral sumatriptan: a case report

Moran

Neligan²

2009

J Med Case Reports

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IntroductionTreatment-resistant trigeminal neuralgia is a distressing condition, for both the patient and the treating doctor. To our knowledge, there are no reported cases of trigeminal neuralgia successfully treated with oral sumatriptan in the literature.Case presentationA 51-year-old Caucasian woman was prescribed opiate analgesia for management of her treatment-resistant trigeminal neuralgia. Given the possible harmful effects of initiating such a course of treatment, a speculative therapeutic trial with oral sumatriptan was initiated with a successful outcome.ConclusionThis case raises the hypothesis that oral sumatriptan may be an effective drug in the treatment of trigeminal neuralgia. Further research is required to test this theory.

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Subcutaneous Sumatriptan for Refractory Trigeminal Neuralgia

Abstract: Subcutaneous sumatriptan produced prompt analgesia without serious adverse reactions in patients with trigeminal neuralgia refractory to previous treatment.

Cited by 62 publications

References 19 publications

Medical management of trigeminal neuropathic pains

Medical management of trigeminal neuropathic pains

Serotonin increases the functional activity of capsaicin-sensitive rat trigeminal nociceptors via peripheral serotonin receptors

Treatment resistant trigeminal neuralgia relieved with oral sumatriptan: a case report

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