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Updated: Jan 15 2018


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  • 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
    • 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
  • Etiology of migraine headache is not fully understood
    • serotonin is involved in the pathophysiology of migraine headaches
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