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