Overview Snapshot A 22-year-old female presents with left-sided, throbbing headache that worsens when lifting groceries or climbing the stairs. Going to a quiet, dark room improves her symptoms. She has tried over-the-counter non-steroidal anti-inflammatory (NSAID) medications and acetaminophen, which provided no relief. Introduction Etiology of migraine headache is not fully understood serotonin is involved in the pathophysiology of migraine headaches Role of serotonin in migraine headaches not well understood. maybe due to action on cranial vasculature or involvement in central pain pathways Mechanism 5-HT1B/1D agonist promotes vasoconstriction inhibits vasoactive peptide release inhibits brainstem pain pathways inhibition of trigeminal nerve activation perhaps secondary to calcitonin gene related peptide (CGRP) level reduction Clinical use migraine headache involved in the abortive therapy of migraine headaches ergotamine can be used as an alternative cluster headache considered first-line in the treatment of acute cluster headaches 100% oxygen is also considered first-line Toxicity coronary vasospasm contraindicated in patients with CAD or Prinzmetal's angina