Pathophysiology and pharmacology of migraine. Is there a place for antiemetics in future treatment strategies?

This article reviews the pathophysiology and pharmacology of emesis in rela tion to migraine pathogenesis. Also, the place of antiemetic and gastrointe stinal prokinetic agents in current and future acute migraine treatment str ategies is reviewed. The mechanisms of action of current and novel acute mi graine therapies are considered with respect to the neurogenic and vascular hypotheses. Control of migraine-associated nausea and vomiting is often ac hieved with the benzamide dopamine D-2 receptor antagonist metoclopramide. This drug also has 5HT(3) receptor antagonist activity and reproducibly sti mulates gastric motility to increase the availability of orally administere d drugs. Other antiemetic and gastroprokinetic agents with potential value for the treatment of migraine-associated nausea and vomiting could speed ab sorption of oral antimigraine therapies without central nervous system side effects. Domperidone, a dopamine D-2 receptor antagonist that does not cro ss the blood brain barrier is relatively free of the central side-effect li ability of metoclopramide. Cisapride, a benzamide 5HT(4) receptor agonist g astrointestinal prokinetic drug, lacks dopamine antagonist activity. A cont rolled comparison of these agents as migraine co-therapies could provide in formation on the importance of peripheral and central mechanisms in migrain e-associated nausea and vomiting and improve antimigraine treatment options .