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- CLINICA NEUROL, 43: 748－751, 2003
- Vol.43 No.11 contents
The 44th Annual Meeting of the Japanese Society of Neurology
Educational Lecture 3:
Pitfall in migraine treatment
Nobuo Araki, M.D.
Department of Neurology, Saitama Medical School
Migraine is a very common disorder. In Japan, an estimated 8.4% of population experience migraine, but most of them go undiagnosed and undertreated. Recent advances in basic and applied clinical neuroscience have led to the development of sumatriptan, a new class of selective serotonin (5-hydroxytryptamine (5-HT)) receptor agonists that activate 5-HT1B/1D receptors. Following sumatriptan several other triptans were produced. They have three main mechanism of action: cranial vasoconstriction, peripheral trigeminal inhibition, and inhibition of transmission through second order neurons of the trigeminocervical complex. Even in our country, we can now use three kinds of triptans, which are very effective medicine against acute migraine with a well-developed scientific rationale. Despite the higher price, triptans were preferred over ergots in most patients.
Recently Limmroth et al reported a prospective study for medication overuse headache (MOH) in 98 patients. The mean critical duration until onset of MOH was shortest for triptans (1.7 years), longer for ergots (2.7 years), and longest for analgesics (4.8 years). The mean critical monthly intake frequencies was lowest for triptans (18 single doses per month), higher for ergots (37), and highest for analgesics (114). We should keep in mind that overuse of triptans leads to MOH faster and with lower dosages compared with ergots and analgesics.
(CLINICA NEUROL, 43: 748－751, 2003)
key words: migraine, serotonin, sumatriptan, triptans, medication overuse headache
(Received: 15-May-03)
