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

Abstract

Abstract—Migraine is a form of primary headache that affects at least 10% of the world’s population. In addition to recommendations for modifying the patient’s lifestyle, migraine management involves stopping an attack that’s already occurred and/or preventing its occurrence. In the abortive treatment of this cephalalgia, both non-specific (eg, non-opioid analgesics) and specific pharmacological agents, can be used. The latter include, in particular, serotonergic drugs of the classes of triptans (selective 5-HT1B/1D receptor agonists), ditans (selective 5-HT1F-mimetics), and ergot alkaloids (non-selective modulators of various 5-HT receptor subtypes). The review discusses the currently availably results of numerous basic and applied studies of these drug groups, in which the neuronal and vascular components of their antimigraine pharmacodynamics were identified. A significant part of the information was obtained in vivo on the various experimental models of migraine based on the trigeminovascular theory of its pathogenesis. Other data are the results of ex vivo studies on isolated tissues and cell cultures. When analyzing these experimental results, evidence is provided in favor of similar mechanisms for realizing the antimigraine potential of all representatives belonging to the pharmacological classes listed, the neurotropic activity of which prevails over their direct intervention in vascular tone. At the same time, special attention is paid to the controversial and debatable issues in this area, the successful solution of which is a key to further progress in the pharmacotherapy of migraine.