Neurology

Migraine Drugs - Triptans & Ergotamines song

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Migraine Drugs - Triptans & Ergotamines

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Triptans (e.g., sumatriptan) are selective 5-HT1B/1D receptor agonists that cause vasoconstriction of dilated meningeal vessels and inhibit trigeminal nerve pain transmission, aborting acute migraine attacks.
Triptans are first-line abortive therapy for moderate-to-severe migraines; they are most effective when taken early in the attack during the headache phase, not during aura.
Triptans are contraindicated in patients with coronary artery disease, uncontrolled hypertension, history of stroke or TIA, and hemiplegic or basilar migraines due to vasoconstrictive risk.
Ergotamines (e.g., dihydroergotamine) are non-selective 5-HT1 agonists with additional alpha-adrenergic and dopaminergic activity; they cause widespread vasoconstriction and are used for refractory or prolonged migraines.
Combining triptans with ergotamines or MAO inhibitors is contraindicated due to risk of severe vasoconstriction and serotonin syndrome, respectively.
Medication overuse headache (rebound headache) is a classic complication of using triptans or ergotamines more than 10 days per month; treatment requires gradual withdrawal of the offending agent.
Ergotamine use in pregnancy is absolutely contraindicated due to potent uterotonic effects that can cause fetal ischemia and spontaneous abortion.
Dihydroergotamine (DHE) given IV or IM is preferred for status migrainosus — a debilitating migraine lasting more than 72 hours — often combined with antiemetics like metoclopramide.
Serotonin syndrome risk increases when triptans are combined with SSRIs, SNRIs, or linezolid; symptoms include hyperthermia, clonus, and autonomic instability.
Preventive migraine therapies (propranolol, topiramate, amitriptyline, valproate) are indicated when migraines occur ≥4 days/month or are significantly disabling, distinguishing them from abortive agents like triptans.