Abstract
Migraine is a chronic, recurrent, disabling condition that affects millions of people worldwide. Proper acute care treatment for migraineurs is based on triptans, a class of specific medications approved over 20 years ago. Triptans are serotonin (5-HT1B/1D) receptor agonists that are generally effective, well tolerated and safe. Seven triptans are available worldwide, although not all are available in every country, with multiple routes of administration, giving to doctors and patients a wide choice. Despite the similarities of the available triptans, pharmacological heterogeneity offers slightly different efficacy profiles. Triptans are not pain medications, they are abortive migraine medications which cannot prevent migraines. In addition to migraine attacks, triptans are also helpful for cluster headaches. If they are useful in other primary headaches rather than migraine and cluster headache it is yet to be addressed. In the literature there are only limited controlled clinical data to support a migraine-selective activity for triptans. Reports are available about efficacy of triptans to stop attacks of other types of primary headache, such as tension type headache, hypnic headache and other rare forms of primary headaches. On the other hand, sumatriptan failed to treat the indomethacin-responsive primary headache disorders like chronic paroxysmal hemicrania and hemicrania continua, nor was it effective in the myofascial temporal muscle pain or in atypical facial pain. Why triptans are effective in so different types of primary headaches remain unclear. Up to date, it is not clear whether the antimigrainous activity of the triptans involves an action only in the periphery or in the CNS as well. Probably we should consider triptans as “pain killers” and not only as “migraine killers”. We clearly need additional studies on triptans as putative analgesics in well-accepted animal and clinical models of acute and chronic somatic pain.
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References
Mondell BE (2003) A review of the effects of almotriptan and other triptans on clinical trial outcomes that are meaningful to patients with migraine. Clin Ther 25(2):331–341
MacGregor EA (2010) Prevention and treatment of menstrual migraine. Drugs 70(14):1799–1818
Allais G, Bussone G, D’Andrea G, Moschiano F, d’Onofrio F, Valguarnera F, Manzoni GC, Grazzi L, Allais R, Benedetto C, Acuto G (2011) Almotriptan 12.5 mg in menstrually related migraine: a randomized, double-blind, placebo-controlled study. Cephalalgia 31(2):144–151
Ashkenazi A, Schwedt T (2011) Cluster headache-acute and prophylactic therapy. Headache 51:272–286
Cady RK, Gutterman D, Saiers JA, Beach ME (1997) Responsiveness of non-IHS migraine and tension-type headache to sumatriptan. Cephalalgia 17(5):588–590
Brennum J, Kjeldsen M, Olesen J (1992) The 5-HT1-like agonist sumatriptan has a significant effect in chronic tension-type headache. Cephalalgia 12(6):375–379
Brennum J, Brinck T, Schriver L (1996) Sumatriptan has no clinically relevant effect in the treatment of episodic tension-type headache. Eur J Neurol 3:23–28
Limmroth V, Kazarawa Z, Fritsche G, Diener H-C (1999) Headache after frequent use of serotonin agonists zolmitriptan and naratriptan. Lancet 353(9150):378
Kaube H, May A, Pfaffenrath V, Diener H-C (1994) Sumatriptan misuse in daily chronic headache. BMJ 308:1573–1574
Gsist D, Tsirpoulus I, Sindrup SH et al (1998) Inappropriate use of sumatriptan. BMJ 316:1352–1353
Mathew N (1999) Headache after frequent triptan use. Lancet 353(9161):1363–1364
Dekker F, Wiendels NJ, de Valk V, van der Vliet C, Knuistingh Neven A, Assendelft WJ, Ferrari MD (2011) Triptan overuse in the Dutch general population: a nationwide pharmaco-epidemiology database analysis in 6.7 million people. Cephalalgia 31(8):943–952
Theeler BJ, Erickson JC (2012) Posttraumatic headache in military personnel and veterans of the Iraq and Afghanistan conflicts. Curr Treat Options Neurol 14(1):36–49
Diener HC, Obermann M, Holle D (2012) Hypnic headache: clinical course and treatment. Curr Treat Options Neurol 14(1):15–26
Schürks M, Kastrup O, Diener HC (2006) Triptan responsive hypnic headache? Eur J Neurol 13(6):666–667
Ipekdal HI, Karadas O, Oz O, Ulas UH (2011) Can triptans safely be used for airplane headache? Neurol Sci 32(6):1165–1169
Berilgen MS, Müngen BA (2011) New type of headache, headache associated with airplane travel: preliminary diagnostic criteria and possible mechanisms of aetiopathogenesis. Cephalalgia 31(12):1266–1273
Basurto Ona X, Martínez García L, Solà I, Bonfill Cosp X et al (2011) Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev 10(8):CD007887
Bussone G, Tullo V, d’Onofrio F, Petretta V, Curone M, Frediani F, Tonini C, Omboni S (2007) Frovatriptan for the prevention of postdural puncture headache. Cephalalgia 27(7):809–813
Hikita T, Kodama H, Kaneko S, Amakata K, Ogita K, Mochizuki D, Kaga F, Nakamoto N, Fujii Y, Kikuchi A (2011) Sumatriptan as a treatment for cyclic vomiting syndrome: a clinical trial. Cephalalgia 31(4):504–507
Russell G, Abu-Arafeh I, Symon DN (2002) Abdominal migraine: evidence for existence and treatment options. Paediatr Drugs 4(1):1–8
Kakisaka Y, Wakusawa K, Haginoya K, Saito A, Uematsu M, Yokoyama H, Sato T, Tsuchiya S (2010) Efficacy of sumatriptan in two pediatric cases with abdominal pain-related functional gastrointestinal disorders: does the mechanism overlap that of migraine? J Child Neurol 25(2):234–237
Kanai A, Saito M, Hoka S (2006) Subcutaneous sumatriptan for refractory trigeminal neuralgia. Headache 46(4):577–582
Kanai A, Suzuki A, Osawa S, Hoka S (2006) Sumatriptan alleviates pain in patients with trigeminal neuralgia. Clin J Pain 22(8):677–680
Shimohata K, Shimohata T, Motegi R, Miyashita K (2009) Nasal sumatriptan as adjunctive therapy for idiopathic trigeminal neuralgia: report of three cases. Headache 49(5):768–770
Ferrari MD, Roon KI, Lipton RB, Goadsby PJ (2001) Oral triptans (serotonin 5-HT(1B/1D) agonists) in acute migraine treatment: a meta-analysis of 53 trials. Lancet 358(9294):1668–1675
Potrebic S, Ahn AH, Skinner K, Fields HL, Basbaum AI (2003) Peptidergic nociceptors of both trigeminal and dorsal root ganglia express serotonin 1D receptors: implications for the selective antimigraine action of triptans. J Neurosci 23(34):10988–10997
Wotherspoon G, Priestley JV (2000) Expression of the 5-HT1B receptor by subtypes of rat trigeminal ganglion cells. Neuroscience 95(2):465–471
Antonaci F, Pareja JA, Caminero AB, Sjaastad O (1998) Chronic paroxysmal hemicrania and hemicrania continua: lack of efficacy of sumatriptan. Headache 38(3):197–200
Dao TT, Lund JP, Rémillard G, Lavigne GJ (1995) Is myofascial pain of the temporal muscles relieved by oral sumatriptan? A cross-over pilot study. Pain 62(2):241–244
Harrison SD, Balawi SA, Feinmann C, Harris M (1997) Atypical facial pain: a double-blind placebo-controlled crossover pilot study of subcutaneous sumatriptan. Eur Neuropsychopharmacol 7(2):83–88
Levy D, Jakubowski M, Burstein R (2004) Disruption of communication between peripheral and central trigeminovascular neurons mediates the antimigraine action of 5HT 1B/1D receptor agonists. Proc Natl Acad Sci USA 101(12):4274–4279
Bingham S, Davey PT, Sammons M, Raval P, Overend P, Parsons AA (2001) Inhibition of inflammation-induced thermal hypersensitivity by sumatriptan through activation of 5-HT(1B/1D) receptors. Exp Neurol 167(1):65–73
De Felice M, Ossipov MH, Wang R, Lai J, Chichorro J, Meng I, Dodick DW, Vanderah TW, Dussor G, Porreca F (2010) Triptan-induced latent sensitization: a possible basis for medication overuse headache. Ann Neurol 67(3):325–327
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Cologno, D., Mazzeo, A., Lecce, B. et al. Triptans: over the migraine. Neurol Sci 33 (Suppl 1), 193–198 (2012). https://doi.org/10.1007/s10072-012-1066-1
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DOI: https://doi.org/10.1007/s10072-012-1066-1