SUMATRIPTAN FOR THE TREATMENT OF MIGRAINE ATTACKS - A REVIEW OF CONTROLLED CLINICAL-TRIALS

Sumatriptan, a 5HT1-like receptor agonist, is a completely new treatme nt principle for migraine. In an extensive international programme of controlled clinical trials, sumatriptan, 6 mg subcutaneously and 100 m g 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 sumatri ptan was superior to Cafergot (2 mg ergotamine plus 200 mg caffeine) a nd 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 ca used rare cases of heart ischemia and sumatriptan is contraindicated i n patients with a history of ischemic heart disease.