Headache sumatriptan

Cluster headache (sumatriptan injection only) Acute treatment of cluster headache episodes. 

Among the indole derivatives which have found use as drugs are indo-methacin, one of the first non-steroidal anti-inflammatory agentsfll], sumatriptan, which is used in the treatment of migraine headaches[12] and pindolol[13], one of the p-adrenergic blockers. 

Sumatriptan succinate is effective for the treatment of acute migraine headaches by acting as... 

Sumatriptan is available for oral, intranasal, and SC administration. The SC injection is packaged as an autoinjector device for self-administration by patients. When compared with the oral formulation, SC administration offers enhanced efficacy and a more rapid onset of action (10 vs. 30 minutes). Intranasal sumatriptan also has a faster onset of effect (15 minutes) than the oral formulation and produces similar rates of response. Approximately 30% to 40% of patients who respond to sumatriptan experience headache recurrence within 24 hours a second dose given at the time of recurrence is usually effective. However, routine administration of a second oral or SC dose does not improve initial efficacy rates or prevent subsequent recurrence. 

Second-generation triptans (all except sumatriptan) have higher oral bioavailability and longer half-lives than oral sumatriptan, which could theoretically improve within-patient treatment consistency and reduce headache recurrence. However, comparative clinical trials are necessary to determine their relative efficacy. 

Sumatriptan and other triptans are antimigraine drugs that possess agonist activity at 5-HTi receptors of the B, D and F subtypes and may thereby alleviate this type of headache (p. 322). 

Not intended for the prophylactic therapy of migraine or for use in the management of hemiplegic or basilar migraine. Safety and efficacy have not been established for cluster headache, which is present in an older, predominantly male population (almotriptan, eletriptan, frovatriptan, sumatriptan tablets and spray, zolmitriptan). 

Gregor N, Schlesiger C, Akova-OztUrk E, Kraemer C, Husstedt I-W, Evers S. Treatment of cluster headache attacks with less than 6 mg subcutaneous sumatriptan. Headache 2005 45 1069-72. 

Given at a dose of 2.5 mg, zolmitriptan can provide relief of headache in 2 hours in about 65% of patients. The rate of recurrence is similar to that for sumatriptan (31%). 

Naratriptan is also dosed at 2.5 mg. Maximum dosage is 5 mg/d. Relief is achieved in 4 hours in 65% of the patients. The rate of reeurrence, an estimated 27%, is similar to that for sumatriptan and zolmitriptan. Frovatriptan is also dosed at 2.5 mg. Relief is achieved in 2 hours in 42% of the patients. Eletriptan is dosed at 40 mg with a maximum dosage at 80 mg. Headache response is achieved in 2 hours in 60% of the patients. Recurence rate is estimated at about 20%. Rizatriptan is dosed at 5 mg with a maximum dosage at 10 mg. Headache response is achieved in 2 hours in 62% of the patients. Recurence rate is estimated at about 39%. 

Wilkinson M, Pfaffenrath V, Schoenen J, Diener HC, Steiner TJ. Migraine and cluster headache their management with sumatriptan a critical review of the current clinical experience. Cephalalgia 1995 15 337-57. 

Longer acting than sumatriptan andzolmitriptan so recurrent headaches requiring a second dose less likely slower onset than sumatriptan andzolmitriptan should probably be reserved for patients who get recurrent headaches... 

Alternative to sumatriptan for the treatment of migraine headache has not been compared head-to-head with sumatriptan choice should be based on cost and availability... 

Effects of sumatriptan (734 patients) or placebo (370 patients) on symptoms of acute migraine headache 60 minutes after injection of 6 mg subcutaneously. All differences between placebo and sumatriptan were statistically significant. 

Sumatriptan Partial agonist at 5-HT1B/1D receptors Effects not fully understood may reduce release of calcitoningene-related peptide and perivascular edema in cerebral circulation Migraine and cluster headache Oral, nasal, parenteral duration 2 h Toxicity Paresthesias, dizziness, coronary vasoconstriction Interactions Additive with other vasoconstrictors... 

Migraine headaches that do not respond to analgesics may be relieved by the use of an agonist of the 5-HT receptor, since these receptors are known to mediate vasoconstriction. Though the causes of migraine are not clear, they are characterized by dilation of cerebral blood vessels. 5-HTi agonists based on the 5-HT structure in current use include the sulphonamide derivative sumatriptan, and the more recent agents naratriptan, rizatriptan,... 

MIGRAINE THE INVOLVEMENT OF SEROTONIN AND THE EFFECTIVENESS OF SUMATRIPTAN IN MIGRAINE HEADACHE... 

When administered during the headache phase of migraine attack, sumatriptan has a rapid effect on all the symptoms headache, nausea, vomiting, photophobia, and phonophobia. This effect applies to both migraine attacks preceded by an aura (classic migraine) and those without an aura (common migraine). Similar but identical effects have been reported for naratriptan, rizatriptan, and zolmitriptan (Brunton et al., 2006). 

Sumatriptan and several other "triptans" are selective agonists for 5-HTiD and 5-HTiB receptors. These receptor types are found in cerebral and meningeal vessels and mediate vasoconstriction. They are also found on neurons and probably function as presynaptic inhibitory receptors. These drugs have proved to be very effective in the treatment of acute migraine headache. The mechanism of action is discussed in more detail below under Clinical Pharmacology of Ergot Alkaloids. 

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