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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The venoconstrictive activity of sumatriptan and its interaction with noradrenaline (NA)- and 5-hydroxytryptamine (5HT) venoconstriction was studied in vivo in the hand vein of migraineurs. Sumatriptan, injected at increasing doses into the vein, caused local venoconstriction after a 500 microgram dose, comparable to that induced by 0.5-1 micrograms of 5HT. This venoconstriction was completely inhibited by low doses of ketanserin (5 micrograms). Subcutaneous sumatriptan (6 mg) provoked a minor increase in vein tone, lasting less than 30 min. Non-venoconstrictive doses of sumatriptan (10-100 micrograms), injected in the hand vein, produced an amplification of NA-venoconstriction but not of 5HT-induced venoconstriction. A similar increased effect was displayed by subcutaneous sumatriptan (6 mg) for at least 1 h. Sumatriptan appears to cause peripheral venoconstriction only at high doses locally applied (in the hand vein), by acting on 5HT2 receptors. Clinical subcutaneous doses (6 mg) do not show significant venoconstrictive effects. The amplifying effect on NA venoconstriction, also caused by 5HT, ergotamine and dihydroergotamine in human cranial arteries, may be important in explaining the therapeutic action of sumatriptan in migraine attacks.
Cephalalgia 1993 Dec
PMID:Amplifying effect of sumatriptan on noradrenaline venoconstriction in migraine patients. 831 46

Sumatriptan is a selective 5-HT1-like agonist, which is effective in the treatment of migraine and cluster headache. It has been rigorously assessed in clinical trials involving over 7000 patients who have treated over 35,000 migraine attacks. Both subcutaneous and oral sumatriptan provide a high level of efficacy with 86% of patients obtaining relief after a single 6 mg injection (at 2 h) and 75% after 100 mg oral sumatriptan (4 h), compared with up to 37% in the placebo-treated group (P < 0.001). The onset of effect is rapid, occurring 10 min after injection and 30 min after the tablet. Oral sumatriptan (100 mg) has been evaluated against ergotamine, 2 mg, plus caffeine, 200 mg (as Cafergot); and against aspirin, 900 mg, plus metoclopramide, 10 mg. Headache relief was superior in sumatriptan-treated patients; 66% obtaining relief at 2 h, compared with 48% on Cafergot (P < 0.001). The percentage of patients obtaining complete relief of headache (Grade 0, no pain) was significantly higher with sumatriptan (40%) than with Cafergot (14%) at 2 h. Associated symptoms such as nausea, vomiting and photophobia are effectively relieved by sumatriptan, whereas Cafergot provoked nausea and vomiting in a proportion of patients. Headache relief with sumatriptan was also superior to that seen with aspirin plus metoclopramide. Sumatriptan was as effective in the relief of accompanying nausea and vomiting as aspirin plus metoclopramide. The efficacy of sumatriptan is maintained after repeated long-term use; over a six-month period efficacy was comparable in the first and last attacks, regardless of how many attacks were treated.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Sumatriptan in the acute treatment of migraine. 838 52

Sumatriptan is a new serotonin receptor agonist that is useful in the treatment of migraine headache. More than 70 percent of patients with migraine headaches respond to subcutaneous sumatriptan within two hours, although headaches recur in up to two-thirds of initial responders. Side effects include lightheadness, a sensation of tingling or warmth, and breathlessness. Compared with the combination of ergotamine and caffeine, sumatriptan appears to work earlier and more completely but is associated with a higher rate of recurrent headache. Sumatriptan may be a useful additional therapy for migraine headache.
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PMID:Sumatriptan: a new serotonin agonist for the treatment of migraine headache. 838 4

Sumatriptan, recently introduced for the treatment of migraine, heralds the beginning of a molecular era in the pharmacological treatment of migraine headache. An indole (non-ergot alkaloid) derivative with agonist properties at a receptor resembling the 5-HT1D subtype (so-called 5-HT1-like receptor), sumatriptan is the first antimigraine medication to exhibit receptor-selective properties. Clinical data indicate that sumatriptan relieves headache, nausea, and photophobia in a majority of acute migraine patients, and it possesses favorable side effect and safety profiles. Of great importance, sumatriptan acts through a novel mechanism that we now know is shared by dihydroergotamine and other useful compounds for the treatment of acute migraine headaches. In this summary, we briefly review the drug's mechanism of action and the emerging clinical experience with its use.
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PMID:SUMATRIPTAN: a receptor-targeted treatment for migraine. 838 98

The study recorded the quantitative changes in psychological status during migraine attack and interval in 20 migraine patients. It further determined their psychological status after administration of the selective 5-HT1-agonist sumatriptan and placebo during migraine interval and migraine attack. psychological status was classified with the aid of an adjective list enabling quantitative description of 15 essential aspects of the subjects' current disposition. The results demonstrate a drastic deterioration in psychological status during an acute migraine attack as compared to the migraine interval and plainly show how badly migraine affects the patients, as almost all the aspects of psychological status are impaired. Administration of placebo did not significantly influence current disposition either in the migraine interval or during the attack. Sumatriptan minimally increased inactivity and dizziness during the migraine interval. During an attack sumatriptan completely normalized current disposition within 30 minutes by significantly improving the impaired dimensions. it is conceivable that this rapid normalization is due to the reduction in pain severity and is only a secondary effect of the rapid alleviation of pain. It is also possible that a direct effect of the selective 5-HT1-agonist on the central nervous system may be the cause of this rapid normalization of current disposition.
Headache 1993 Mar
PMID:Psychological status during migraine attack and interval before and after treatment with a selective 5-HT1-agonist. 838 74

The headache phase of the migraine attack is thought to be associated with a dilation of cranial blood vessels, particularly those in the dura mater, and an accompanying localized sterile inflammatory response. Serotonin, or 5-hydroxytryptamine (5-HT), is considered a possible mediator of this syndrome. Receptors for 5-hydroxytryptamine are present in cranial arteries and are widely distributed in the CNS. Studies indicate that sumatriptan, a 5-HT1 receptor agonist, is effective in treating acute migraine attacks. The mechanism of sumatriptan's therapeutic action is not completely understood. Evidence from animal and human studies suggests that sumatriptan constricts dural vessels and inhibits neuropeptide release from trigeminal nerve endings by activating 5-HT1 receptors. Clinically, sumatriptan is rapidly effective against all features of the headache phase in migraine in up to 80% of patients. The headache may recur, however, within 24 hours in about one third of patients, but this can be treated effectively with a subsequent dose of sumatriptan. Treatment with sumatriptan has been well tolerated with only minor, transient, acute side effects reported. At present, only limited information is available regarding long-term tolerability, safety, and efficacy. Sumatriptan should not be prescribed to patients with a cardiovascular history.
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PMID:Sumatriptan in the treatment of migraine. 838 11

A female patient is described who had a four year long period of unilateral chronic paroxysmal hemicrania (CPH) which then became bilateral. For some years before the CPH started she suffered from periods of about one month with chronic hemicrania without nerve involvement. She also suffered from chronic fatigue, back pain, arthralgia, vertigo, chronic constipation and spontaneous ecchymoses. Blood tests showed chronic leukocytosis, low serum iron, and signs of inflammation in serum electrophoresis during the five years she was studied. CPH attacks could be provoked by breathing 6% carbon dioxide in air. Lumbar cerebrospinal fluid pressure was pathologically increased (30 cm water). The attacks decreased during indomethacin treatment but 275 mg was needed for satisfactory control of the attacks, i.e., more than the 150 mg which, according to the criteria for CPH, should be absolutely effective. Sumatriptan was found to suppress the CPH attacks as well as indomethacin. Due to these findings CPH is considered to be another manifestation of venous vasculitis. The beneficiary mechanism of indomethacin in CPH is considered to be due partly to its anti-inflammatory effects and partly to its reduction of the intracranial blood flow.
Headache 1993 Jun
PMID:Intracranial hypertension and sumatriptan efficacy in a case of chronic paroxysmal hemicrania which became bilateral. (The mechanism of indomethacin in CPH). 839 1

Sumatriptan, a 5HT1-like receptor agonist, is a completely new treatment principle for migraine. In an extensive international programme of controlled clinical trials, sumatriptan, 6 mg subcutaneously and 100 mg orally, was superior to placebo in reducing headache and associated symptoms. The response rate for subcutaneous sumatriptan (70-84% after 1 h and 81-87% after 2 h) was higher than for oral sumatriptan (50-67% after 2 h). Additional doses did not increase efficacy. Oral sumatriptan was superior to Cafergot (2 mg ergotamine plus 200 mg caffeine) and somewhat better than aspirin (900 mg) plus metoclopramide (10 mg). Recurrence of migraine occurred in approximately 40% of attacks. Side effects were generally mild and short-lived in the controlled clinical trials. However, in clinical practice sumatriptan has subsequently caused rare cases of heart ischemia and sumatriptan is contraindicated in patients with a history of ischemic heart disease.
Cephalalgia 1993 Aug
PMID:Sumatriptan for the treatment of migraine attacks--a review of controlled clinical trials. 839 70

Sumatriptan is a potent and selective agonist at the vascular 5HT1 receptor which mediates constriction of certain large cranial blood vessels and/or inhibits the release of vasoactive neuropeptides from perivascular trigeminal axons in the dura mater following activation of the trigeminovascular system. The mode of action of this drug in migraine and cluster headache is discussed. On the basis of a detailed review of all published trials and available data from post-marketing studies, the efficacy, safety, tolerability and the place of oral and subcutaneous sumatriptan in the treatment of both conditions are assessed. A number of double-blind clinical trials have demonstrated that sumatriptan 100 mg administered orally is clearly superior to placebo in the acute treatment of migraine headache and achieves significantly greater response rates than ergotamine or aspirin. In other studies, 70 to 80% of patients receiving sumatriptan 6 mg sc experienced relief of migraine headaches by 1 or 2 h after administration, and patients consistently required less rescue medication for unresolved symptoms. Sumatriptan was also effective in relieving associated migraine symptoms like nausea and vomiting. Sumatriptan was equally effective regardless of migraine type or duration of migraine symptoms. Overall, approximately 40% of patients who initially responded to oral or subcutaneous sumatriptan experienced recurrence of their headache usually within 24 h, effectively treated by a further dose of this drug. In 75% of patients with cluster headache treated with sumatriptan 6 mg sc, relief was achieved within 15 min. Based on pooled study data, sumatriptan is generally well tolerated and most adverse events are transient. Adverse events following oral administration include nausea, vomiting, malaise, fatigue and dizziness. With the subcutaneous injection, injection site reactions occur in approximately 30%. Chest syumptoms are reported in 3 to 5% but have been associated with myocardial ischaemia only in rare isolated cases. The recommended dosage of sumatriptan at the onset of migraine symptoms is 100 mg orally or 6 mg subcutaneously. The recommended dosage for cluster headache is 6 mg sumatriptan sc. Sumatriptan must not be given together with vasoconstrictive substances, e.g., ergotamines, or with migraine prophylactics with similar properties, e.g., methysergide. Sumatriptan should not be given during the migraine aura. It is contraindicated in patients with ischaemic heart disease, previous myocardial infarction, Prinzmetal (variant) angina and uncontrolled hypertension.
Cephalalgia 1995 Oct
PMID:Migraine and cluster headache--their management with sumatriptan: a critical review of the current clinical experience. 853 93

A novel self-injector for the administration of subcutaneous sumatriptan in the treatment of migraine attacks was tested in 138 patients recruited by family physicians in Denmark: 108 patients completed the initial double-blind, crossover part of the study. Sumatriptan 6 mg s.c. was significantly better than placebo at 30, 60, 90 and 120 min after injection in relieving moderate or severe headache to mild or none as well as relieving any headache to none. At 60 min after injection, the treatment response rate was 61% for sumatriptan and 6% for placebo. During the following open-phase trial of four attacks treated with sumatriptan, treatment response rates were 68-74%. During the total of 538 attacks treated, 12 attempts at using the self-injector failed. In the double-blind and open phases, 81% and 90% of patients respectively found the device easy or very easy to use. Adverse effects were benign and short-lasting, but led seven patients to discontinue the study. In conclusion, subcutaneous sumatriptan administered with a novel self-injector is an effective treatment for migraine compared to placebo in patients treated by their family physician.
Cephalalgia 1995 Oct
PMID:Introduction of a novel self-injector for sumatriptan. A controlled clinical trial in general practice. 853 4


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