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An evaluation of sumatriptan (a serotonin 1D agonist) as a new therapy in the treatment of acute migraine attack / Susan S.C. Man

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Identifier	Thesis 1594
Author	Man, Susan S. C.
Title	An evaluation of sumatriptan (a serotonin 1D agonist) as a new therapy in the treatment of acute migraine attack / Susan S.C. Man
Publisher	Central Connecticut State University
Date	2000
Resource Type	Master's Thesis
Notes	To date, the exact etiology of migraine remains unknown. However, the medical community has accepted Moskowitz’s trigeminovascular hypothesis as the most acceptable explanation. Moskowitz proposes that both the trigeminovascular system and the serotonergic system are involved in the manifestation of migraine. Serotonin is a vasoactive neurotransmitter, which also plays an important part in pain modulation. During a migraine attack, a significant fall in plasma serotonin (5-hydroxy-tryptamine or 5-HT) is observed. The results are disregulation in the endogenous pain control pathway, loss of tonic vasoconstriction of the cerebral vasculature, and release of neuropeptides (inflammatory mediators) at the nociceptive afferent terminals of the trigeminal nerve causing neurogenic inflammation (vasodilation and plasma extravasation). Further investigation into serotonin led to the discovery of serotonin receptors, the mediators for the effects of serotonin. The 5-HT1D serotonin receptors are the most abundant receptors in the human brain. Stimulation of the 5-HT1D serotonin receptors leads to the blockage of neuropeptide release at the trigeminovascular junction and cessation of migraine pain. Sumatriptan is the first 5-HT1D agonist introduced as treatment for acute migraine. Under the guidelines of the International Headache Society (IHS), the efficacy and safety of sumatriptan has been evaluated by large scale clinical studies conducted in the United States, the United Kingdom, and Europe. Sumatriptan has proved to be extremely effective as a treatment for acute migraine. Pain relief is obtained irrespective of the type of migraine, duration of attack, or the patient's gender or age. Subcutaneous sumatriptan provides the most rapid pain relief, in comparison with oral or nasal sumatriptan. Sumatriptan is also found to be safe and well-tolerated, with low abuse potential if administered within recommended dosages. Adverse events are mainly transient and mild. Some of the most common adverse events are minor pain and erythema at injection site, flushing, chest discomfort, neck stiffness, tingling sensation, and fatigue. Life threatening events such as coronary vasospasm and arrhythmias are extremely rare (1% or less). However, patients with cardiac history should receive a full cardiovascular evaluation before taking sumatriptan. Patients with renal or hepatic dysfunction should receive adjusted dosages to compensate for altered absorption, metabolism and excretion of the drug. Current data show that absolute contraindication is no longer warranted when sumatriptan is used concomitantly with monoamine oxidase inhibor (MAOI), if dosages of sumatriptan are carefully adjusted to avoid increased bioavailability and decreased clearance. The positive impact of sumatriptan on quality of life has been indicated in eight clinical trials conducted in the United States, Germany, and France. Various aspects of daily activities are shown to be noticeably improved in the long-term. Increased productivity and decreased absenteeism are observed secondary to sumatriptan treatment received by workers with migraine. The social and economic benefits provided by sumatriptan are thus evident. The success of sumatriptan has lead to the development of other 5-HT1D agonists. Sumatriptan has also aroused significant new interests regarding migraine. Hopefully, vigorous efforts will be made to combat migraine through further research and education.
Subject	Migraine Serotonin -- Agonists
Department	Department of Biological Sciences
Advisor	Rollin, Ruth
Type	Text
Digital Format	application/pdf
Language	eng
OCLC number	45242897
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Home CCSU Theses & Dissertations An evaluation of sumatriptan (a serotonin 1D agonist) as a new therapy in the treatment of acute...

An evaluation of sumatriptan (a serotonin 1D agonist) as a new therapy in the treatment of acute migraine attack / Susan S.C. Man

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