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A case study of an otherwise healthy 23-year-old woman with headaches and associated symptoms that occur twice a month and diagnosed for migraine without aura is presented. The patient unresponsive to NSAIDs or combination of analgesics was observed to obtain complete relief of headache and associated nausea with subcutaneous sumatriptan and hence recommended an oral triptan.

The genes coding for human serotonin 1D receptors were isolated from a human hippocampus cDNA library and a human genomic library. Further analyses showed that the genes code receptors of highly similar sequence, pharmacological properties and second messenger coupling. Based on their similarities, the receptors were designated serotonin 1D-alpha and serotonin 1D-beta. Therefore, these receptors represent two subtypes of a subfamily of serotonin 1D receptors. Both were found to bind to sumatriptan, making them prime targets for the action of this drug.

Migraine headache is a painful, often debilitating condition from which approximately 8,000,000 Americans suffer. Attacks may be as frequent as several times per month, and are associated with significant loss in productivity and diminished quality of life. Currently available prophylactic (preventive) and therapeutic medications are inconsistent in their effectiveness, and have side effects that are often intolerable. The cause of migraine, while not fully understood, is thought to be related to dilation (relaxation and increased diameter) of cranial blood vessels. The neurotransmitter serotonin is effective in the treatment of migraine, but its adverse side effects prevent routine use. Sumatriptan is a compound that is known to stimulate a particular type of serotonin receptor - the cellular site responsible for seratonin's actions. This causes constriction of cranial blood vessels; consequently, sumatriptan may be a useful therapeutic agent for the treatment of migraine. To determine the effectiveness of this compound, two parallel-group trials involving 1,104 subjects were held at different medical centers in the United States. Subjects were administered either 6 milligrams of sumatriptan succinate or an inactive placebo by subcutaneous (under the skin) injection. One hour following injection, sumatriptan had reduced severe or moderate migraine pain to mild or no pain in 70 percent of the cases, compared with 22 percent of the subjects given placebo. In addition, sumatriptan was more effective than placebo at completely relieving headaches (49 percent versus 9 percent), lessening migraine-induced disability (76 percent versus 34 percent), and reducing nausea and sensitivity to light. The 365 patients suffering from residual migraines received a second injection of either sumatriptan or placebo; there was no evidence of any further reduction in the severity of symptoms resulting from the second injection. Adverse effects included tingling, dizziness, warm-hot sensations, and reactions at the sites of injection. (Consumer Summary produced by Reliance Medical Information, Inc.)

JAMA. 2007;297:1443-1454 [April 4, 2007] Treating migraine headaches with both sumatriptan and naproxen sodium produces a longer pain-free response and a greater reduction of photophobia and phonophobia than either agent [...]

Byline: Giorgio Zanchin (1), Filippo Dainese (1), Federico Mainardi (1), Ferdinando Maggioni (1) Keywords: Key words Triptans; Migraine; Clinical use; Sumatriptan, Zolmitriptan; Rizatriptan Abstract: Many drugs are now available for treating migraine attacks, including agents specifically indicated for this condition. Since 1990 sumatriptan, the first 5-HAT.sub.1B,1D receptor agonist, was introduced and realized a real breakthrough in therapy other agents of this class of drugs called triptans have more recently been used. All of them are effective in relieving the symptoms of migraine, but each exhibits pharmacological and/or clinical features that must be considered for the optimal care and management of the patient. We present here a short overview on the main clinical features of the triptans already in use in Italy. Author Affiliation: (1) Department of Neurosciences, University of, Via Giustiniani 5, I-35128 Padua, Italy, e-mail: giorgio.zanchin@unipd.it, Tel.: 049-8213600/26, Fax: 049-8751770, IT

Sumatriptan nasal spray may be particularly useful for patients whose nausea and vomiting preclude them from using oral migraine medication or for patients who prefer not to use an injectable migraine medication. The objective of this study was to evaluate in two clinical studies the efficacy and tolerability of the intranasal form of sumatriptan in the acute treatment of a single migraine attack. International Headache Society-diagnosed adult migraineurs in two randomized, double-blind, parallel-group, multicenter studies (n = 409 and 436) used sumatriptan nasal spray 20 mg, 10 mg, or placebo (2:1:1) for the acute treatment of a single migraine attack at home. Predose and at predetermined postdose intervals, patients recorded headache severity (none, mild, moderate, severe); time to meaningful relief; clinical disability (none, mildly impaired, severely impaired, bed rest required); presence/absence of nausea, photophobia, and phonophobia; and the occurrence of adverse events. Two hours postdose in the two studies, moderate or severe baseline pain was reduced to mild or none in 62 to 63% of patients treated with sumatriptan 20 mg, 43 to 54% of patients treated with sumatriptan 10 mg, and 29 to 35% of placebo-treated patients (P [is less than] 0.05 20 mg versus placebo for both studies and 10 mg versus placebo for study 1). Onset of relief relative to placebo began as early as 15 minutes postdose (sumatriptan 20 mg, study 2). Clinical disability at 2 hours postdose was reported as mildly impaired or normal in 72 to 74% of patients treated with sumatriptan 20 mg, 56 to 68% of patients treated with sumatriptan 10 mg, and 47 to 58% of placebo-treated patients (P [is less than] 0.0520 mg versus placebo for both studies). Similar efficacy rates were observed for nausea, photophobia, and phonophobia. The most common adverse event in the active treatment groups was disturbance of taste (bad, bitter, or unpleasant taste). Aside from this event, the pattern and incidence of adverse events did not differ among treatment groups. From these results we determined that sumatriptan nasal spray is a rapidly effective, well- tolerated migraine treatment. The 20-mg dose was effective in treating the entire migraine symptom complex, and the 10-mg dose was less consistently effective. (1997;49:1225-1230) Robert Ryan et al, 621 S New Ballas Rd, Suite 537, St Louis, MO 63141.