Neurophysiological and Vascular Mechanisms of Action of Serotoninergic Drugs for Abortive Migraine Treatment.

Migraine is a form of primary headache that affects at least 10% of the world's population. In addition to advising patients to modify their lifestyles, the management of migraine includes terminating ongoing attacks and/or preventing attacks from occurring. Pharmacological agents of both nonspecific (for example, non-narcotic analgesics), and specific actions can be used for the abortive treatment of this form of headache. Specific treatments include, in particular, serotoninergic agents: triptans (selective 5-HT1B/1D receptor agonists), ditans (selective 5-HT1F-mimetics) and ergot alkaloids (non-selective modulators of various subtypes of 5-HT receptor). This review presents the currently known results from many basic and applied studies of drugs from these groups, identifying the neuronal and vascular components of their anti-migraine pharmacodynamics. Significant quantities of these data were obtained in vivo in a variety of experimental models of migraine based on the trigeminovascular theory of its pathogenesis. Other information is based on ex vivo work on isolated tissues and cell cultures. Analysis of results from these studies yielded evidence in favor of the notion that the anti-migraine potential of members of all of these pharmacological classes is mediated by similar mechanisms, whereby neurotropic activity dominates over direct intervention in vascular tone. Special attention is paid to uncertain and controversial issues in this area, whose successful solution is key to further progress in the pharmacotherapy of migraine. [ABSTRACT FROM AUTHOR]