A New Approach to Acute Migraine Treatment
Mary A . Franklin National Headache Foundation
Chicago , IL
Serotonin is a neurotransmitter that is involved in the transmission of nerve impulses . It can trigger the release of substances in the blood vessels of the brain that in turn cause the pain of migraine . Serotonin is also key to mood regulation ; pain perception ; gastrointestinal function , including perception of hunger and satiety ; and , other physical functions .
During the 1970s , Patrick P . A . Humphrey and his team of researchers at Glaxo in the United Kingdom attempted to identify the serotonin receptor types responsible for the beneficial effects of serotonin in headache . They identified a serotonin receptor , type 5-HT1B , which is mainly found in cranial blood vessels rather than peripheral blood vessels . Because of this discovery , the scientists were able to design agonists that could stimulate the receptors and trigger constriction of the cranial blood vessels and help terminate an acute migraine attack . In 1988 , they utilized a serotonin ( 5-HT )( 1B / 1D ) agonist called sumatriptan to treat migraine and certain other headaches . The triptans act by binding to serotonin receptors in the brain , which leads to a reversal of blood vessel swelling . Sumatriptan was effective for their patients and it was well-tolerated .
Sumatriptan was approved in the US by the Food and Drug Administration ( FDA ) and became available by prescription in 1992 . Initially , sumatriptan was only administered as a subcutaneous injection . Eventually , other triptans were approved and were available in a variety of forms for administration , including oral , intranasal , and intradermal . In 2013 , the FDA approved a singleuse , disposable patch system that delivers sumatriptan through the skin . Teva Pharmaceuticals acquired this drug , Zecuity ®, in 2014 , and it became available by prescription in the US in September , 2015 .
Because nausea and / or vomiting are associated symptoms of an acute migraine attack , patients may delay treatment or avoid using drugs that are available as oral preparations . The use of a patch system helps the patient avoid using agents that would be metabolized by the GI tract .
Zecuity ® is worn on the upper arm or thigh for about a 4-hour period , during which sumatriptan is delivered through the skin . It is prepared in an iontophoretic transdermal system that uses a mild electrical current through the skin to deliver the drug . The system is single use , battery-operated , and disposable .
In one study of Zecuity ®, at 2 hours following application , 18 % of patients using this drug reported no headache pain as compared to 9 % of patients using a non-medicated patch system . Also , at 2 hours following application of the system , 84 % of the patients in the group with active drug reported no nausea as compared to 63 % of patients in the second group . Other significant improvements were noted in sensitivity to sound ( 55 % versus 39 %), sensitivity to
20 HeadWise ® | Volume 5 , Issue 1 • 2015