Sumatriptan and cerebral blood flow velocity changes during migraine attacks

Transcranial Doppler studies on the effects of sumatriptan on cerebral hemodynamics have shown conflicting results. We evaluated blood flow velocity changes in 21 patients suffering from migraine with (n=4) or without aura (n=17) during a spontaneous attack, before and after treatment with sumatriptan. Flow velocity in the internal and external carotid, middle cerebral, and basilar arteries was measured by means of transcranial Doppler. During the attack, measurements were taken before subcutaneous sumatriptan injection, then after 30 minutes, 2 hours, and 24 hours. An additional measurement was taken 1 week later in a headache-free state. We found a significant reduction of flow velocity during the attack in the middle cerebral artery on both sides (P<0.05). After sumatriptan administration, flow velocity increased in the internal carotid artery on both sides (P<0.05) and in the middle cerebral artery on the headache side (P=0.0001), but not in the external carotid and basilar arteries (P>0.05). Flow velocity changes may reflect the vasodilation present at the onset of the migraine attack followed by vasoconstriction in the internal carotid and middle cerebral arteries after sumatriptan treatment. Since vasoconstriction occurs in responders and nonresponders to treatment, it is unlikely to be the primary mechanism by which sumatriptan relieves headache.