Int Clin Psychopharmacol. 2002 Jan;17(1):33-36

An association between bipolar disorder and migraine has been lately recognized and an abnormality of central serotonergic function is suggested as the underlying neurophysiological disturbance. To examine the role of serotonin in bipolar disorder and migraine, we used the neuroendocrine challenge paradigm, and we chose sumatriptan, a 5HT1D agonist, as the pharmacological probe. We studied nine bipolar patients with migraine, nine bipolar patients without it, seven migraine patients, and nine matched normal controls. A post-hoc analysis showed subsensitivity of serotonergic function, reflected in a blunted growth hormone response to sumatriptan challenge in bipolar patients who also suffered from migraine.

Comment: Given regulatory and labelling concerns about the potential for triptans to provoke serotonin syndrome, the apparent down-regulation of serotonergic function in patients with bipolar disorder may suggest cause for cautious optimism and encourage future study of triptans in these patients to establish true causality or otherwise.

A prospective trial of sumatriptan injectable identified 1700 patients who repetitively used the triptan and were concomitantly on selective serotonin reuptake inhibitor (SSRI) medication. No serotonin syndrome was reported in any patient (Putnam GP, O'Quinn S, Bolden-Watson CP, Davis RL, Gutterman DL, Fox AW. Migraine polypharmacy and the tolerability of sumatriptan: a large-scale, prospective study. Cephalalgia. 1999;19:668-675). Since SSRIs can rarely induce serotonin syndrome alone, there is a significant difficulty in establishing a risk of coadministration. DSM and SJT