From The New England Center for Headache, Stamford, CT (Dr. Rapoport); Palm Beach Headache Center, West Palm Beach, FL (Dr. Winner).
Nasal Delivery of Antimigraine Drugs: Clinical Rationale and Evidence Base
Version of Record online: 27 OCT 2006
Headache: The Journal of Head and Face Pain
Volume 46, Issue Supplement s4, pages S192–S201, November 2006
How to Cite
Rapoport, A. and Winner, P. (2006), Nasal Delivery of Antimigraine Drugs: Clinical Rationale and Evidence Base. Headache: The Journal of Head and Face Pain, 46: S192–S201. doi: 10.1111/j.1526-4610.2006.00603.x
- Issue online: 27 OCT 2006
- Version of Record online: 27 OCT 2006
- dihydroergotamine mesylate;
- migraine treatment;
- nasal spray migraine treatment;
- migraine treatment efficacy;
The intranasal route of administration for antimigraine drugs offers many theoretical and practical advantages. A drug that is administered intranasally is absorbed by the highly vascular mucous membranes of the nose, which allows for rapid delivery of un-metabolized drug to the central nervous system. The onset of action is thus considerably earlier than with oral administration requiring gastrointestinal absorption. The intranasal route also provides several practical advantages, such as greater acceptability to patients because of the noninvasive mode of delivery, the ability to take medication when severe nausea or vomiting is present, and a better adverse event profile. Three antimigraine drugs are available in intranasal formulation: dihydroergotamine, sumatriptan, and zolmitriptan. This article reviews the pharmacology, efficacy, safety, and tolerability of these agents. All are well tolerated by patients and have demonstrated efficacy in the treatment of migraine headache. Each of these drugs has a unique pharmacokinetic and pharmacodynamic profile, which may support a clinical preference for one intranasal agent over another in treating patients with specific headache features.