What Happens to the Old
Headache Medicines? Rapoport AM, MD. Old
headache medicines never die; they either fade away or come back in disguise. The disguise is often a new route of administration, which may work better, faster, more completely, with fewer adverse events, and/or have certain other advantages. The clinical aspects of 3 of the oldest
headache medicines (
ergotamine tartrate,
dihydroergotamine, and
methysergide) will be discussed here.
Sumatriptan will then be discussed as the prototype of the newest category of acute care
therapy (
triptans) for
migraine. It will be compared with the older medications, and the new forms being developed will be briefly discussed.
Diclofenac potassium for oral
solution will be mentioned as the newest
drug approved for
migraine by the Food and Drug Administration and a possible alternative to
triptans in patients with frequent
headaches or those with
contraindications to
vasoconstrictors.
Dihydroergotamine,
Ergotamine,
Methysergide and
Sumatriptan - Basic Science in Relation to
Migraine Treatment. Dahlöf C, Maassen Van Den Brink A. The
5-hydroxytryptamine (5-HT) receptor family mediates the effects of several drugs highly effective in
migraine primarily by activating 5-HT(1B) , 5-HT(1D) , and 5-HT(1F) receptors.
Ergotamine,
dihydroergotamine and
methysergide, as well as the "
triptan"
sumatriptan, are all agonists for these receptors. The receptor profile and degree of selectivity of these 4 drugs differ, which is reflected by their side effects that limit their use in the acute and prophylactic treatment of
migraine. The acute antimigraine efficacy of these remedies is very much dependent on the formulation used where, in general, parenteral formulations are more effective in relieving the symptoms of a
migraine attack.