On serotonin and migraine: a clinical and pharmacological review

Authors

  • Michel D Ferrari,

    Corresponding author
    1. Department of Neurology, University Hospital, Leiden, The Netherlands;
    2. The Dutch Migraine Research Group, The Netherlands
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  • Pramod R Saxena

    1. Department of Pharmacology, Erasmus University, Rotterdam, The Netherlands;
    2. The Dutch Migraine Research Group, The Netherlands
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MD Ferrari, Department of Neurology, PO Box 9600, 2300 RC Leiden, The Netherlands.

Abstract

Migraine patients have chronically low systemic 5-HT, predisposing them to develop migrainous headache once an attack has been initiated. Changes in platelet 5-HT content are not causally related, but reflect similar changes at a neuronal level. Stimulation of vascular 5-HT1 receptors, probably located in the vessel wall within the dural vascular bed, may alleviate the headache and associated symptoms, but does not interact with earlier mechanisms within the pathophysiological cascade. These receptors are of an as yet unidentified 5-HT1 subtype, closely resembling, but not identical to 5-HT1D receptors. Activation of these receptors results in vasoconstriction, inhibiting depolarization of sensory perivascular afferents within the trigemino-vascular system and thus stopping the headache. Additional inhibition of the release of vasoactive neuropeptides may be involved, but seems to be of only secondary clinical importance.

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