[Emergency treatment of migraine attacks with particular reference to agonists of 5-HT1B/1D receptor]

The author discusses the modern methods of emergency controlling of migraine attacks, especially the recently introduced drugs agonists of the 5-HT 1B/1D receptor /Sumatriptan, Zolmitriptan/ and prophylactic treatment. In light and moderately severe attacks analgesics are usually effective as well as non-steroid antiinflammatory drugs /paracetamol, acetylsalicylic acid, naproxen, diclofenac, ibuprofen, ketoprofen etc./ with or without addition of caffeine and codeine, and metoclopramide /for suppression of nausea and vomiting/ or Torecan. Ergotamine is still in use, although it can produce serious adverse effects. An essential advance in the treatment of more severe attacks was achieved with the introduction of Sumatriptan, a selective 5-HT1D receptor agonist in 1988. In pursuing this direction further indole derivatives /so called triptans/ were introduced. Zolmitriptan introduced in 1994 is an agonists of 5-HT 1B/1D receptor, is active both peripherally and centrally, is well absorbed from the digestive tract and has a good bioavailability index /40%/. In 2.5 mg doses it causes regression or marked alleviation of migraine attack within 2 hours in 70% of cases. Administration of a second dose after that time increases the percentage of successes. Adverse effects are usually mild, coronary complication have not yet been described. Prophylactic treatment is given to patients with attack frequency over 2 in a month. For that treatment usually dihydroergotamine, pisotifen, propranolol, metoprolol, flunarizin, valproic acid, iprasochrom and oxetoron are given.