Triptans. A substantial advance in the acute treatment of migraine

Triptans are medicinal products with a serotoninergic (5HT) agonist action for 1 B-D type receptors that have proven efficacy in the relief of the pain and symptoms accompanying migraine crises. The 5HT 1 B-D receptors are present in the brain trigeminal-vascular terminations, the meningeal vessels and the trigeminal nucleus of the brain stem. Their activation inhibits vasodilatation and edema of cranial arteries, and activation of the pain transmitting neurons of the trigeminal nucleus. An analysis was made of the pharmacokinetic parameters of triptans (suma, nara, zolmi, riza, almo) and their clinical efficacy on the basis of the results of a meta-analysis published in Lancet (2001). All the triptans were more effective than classic treatments such as ergotamine and bring about pain relief in 60-80% of the crises treated. The efficacy of rizatriptan, almotriptan and eletriptan (80 mg) was greater than that of sumatriptan. Sumatriptan is the only one that is also presented as a parenteral formulation. The coronary vasoconstrictor action of triptans, although small, means that they are contraindicated in patients with heart disease and/or uncontrolled high blood pressure. They should be associated with caution with selective serotonin re-uptake inhibitors and lithium as cases of serotonin syndrome have been described. Their adverse reactions are almost irrelevant and include paresthesia, dizziness or oppression of the chest not related to coronary ischemia.