Treatment of acute migraine attacks - New developments in headache research

The development of new serotonin (5-HT) agonists for the treatment of acute migraine attacks has stimulated serotonin research and resulted in new insights into the pharmacology of 5-HT1-receptors. The current nomenclature of 5-HT receptors includes seven classes named 5-HT1 through 5-HT7. Within the 5-HT there are the receptor group subreceptor types A, B, D, E and F. The 5-HT1B/1D-agonists are effective and specific anti-migraine drugs. Their mode of action includes vasoconstrictive effects in the carotid territory and inhibitory effects on the peripheral and central pain transmission within the trigeminal system. The currently or future approved drugs for the treatment of acute migraine attacks sumatriptan, naratriptan, zolmitriptan, rizatriptan and eletriptan have a similar efficacy, side effect profile and recurrence rate. Substances that inhibit substance-P release, endothelin antagonists and CP122.288 are not effective in human migraine. New drugs under investigation are 5-HT1F agonists, inhibitors of NO synthesis and CGRP antagonists.