Sumatriptan, a 5-hydroxytryptamine 1 (5-HT 1 ) receptor agonist is an effective abortive agent for migraine headaches. A common side effect in 3% to 7.9% of patients is chest pain. Although most cases of chest pain are not thought to be of cardiac origin, its mechanism is not entirely understood. Rare examples of electrocardiogram changes consistent with transient ischemia have been reported. Isolated instances of angina, arrhythmia, myocardial infarction, and death have been temporally associated with sumatriptan administration. In most cases, it is unclear whether underlying cardiovascular disease existed or contributed to this adverse event. We report the history of a 56-year-old female patient with migraine who experienced myocardial infarction shortly after using sumatriptan, despite having had a normal cardiovascular evaluation. As she had a normal cardiac catheterization after the event, we find it probable that sumatriptan induced coronary vasospasm and myocardial infarction.Key words: migraine, sumatriptan, vasospasm, myocardial infarction ( Headache 1996;36:329-331) Sumatriptan, a selective agonist of 5-hydroxytryptamine, (5-HT 1 ) receptors, is an effective migraine abortive agent. 1 Its mechanism of action is thought to be cranial vasoconstriction, mediated by the inhibition of neuroinflammatory peptide release. 2,3 A self-injector unit is available in the United States for subcutaneous administration of 6 mg of sumatriptan as the succinate salt. 2,3 It is believed that most other vascular beds in the body have 5-HT 2 mediated vasoconstriction, and therefore, should not be affected by sumatriptan. 4 Recent studies, however, have found 5-HT 1 -like receptors on coronary arteries. 4-7 A few studies suggest that damaged or atheromatous coronary arteries may be more prone to 5-HT 1 mediated vasoconstriction, 4,5 and the manufacturer has recommended a cardiovascular evaluation prior to sumatriptan use for patients at risk for coronary disease. 3 One study found sumatriptan to act as a full agonist on 5HT 1 -like receptors on normal coronary arteries. 6,7 Coronary vasospasm has been induced by sumatriptan during cardiac catheterization. 4,8 Electrocardiogram changes suggestive of transient ischemia have been reported. 3,9-12 Isolated instances of angina, arrhythmia, myocardial infarction, and death have been reported after administration of sumatriptan. [13][14][15][16][17] It is often difficult to discern whether unsuspected coronary artery disease contributed to adverse cardiac outcomes with sumatriptan. We document the case of a 56-year-old woman who experienced a non-Q wave anterior myocardial infarction temporally related to an injection of sumatriptan for the treatment of a migraine headache. She had a normal routine electrocardiogram and exercise stress test prior to using the medication and a normal cardiac catheterization after the incident.
CASE HISTORYA 56-year-old woman was admitted to the hospital after experiencing 5 1/2 hours of severe retrosternal chest pain radiating to her left breast,...
