Pharmacological opportunities and pitfalls in the therapy of migraine

The mild vasoconstrictor effects of modern antimigraine drugs, such as sero tonin (5-HT; 5-hydroxytryptamine) (1B/D) agonists, have led to a search for nonvasoconstrictor approaches to therapy. Such approaches have included su bstance P (neurokinin I) antagonists, endothelin antagonists and highly spe cific 5HT(1D) agonists, All of these substances are effective in animal mod els and have no significant vasoconstrictive effects. However, all of them failed to demonstrate any antimigraine effects. Current clinical and experi mental evidence therefore supports the view that isolated peripheral trigem inal nerve inhibition is insufficient to relieve acute migraine. Curr Opin Neurol 14:341-345. (C) 2001 Lippincott Williams & Wilkins.