Selective 5-HT1B/1D receptor agonist useful in acute migraine is:
Triptans like sumatriptan, frovatriptan etc are 5HT1B/1D agonists. These are drug of choice for acute severe migraine. Ergot alkaloids like ergotamine can also be used for acute attack of migraine. These also stimulate 5HT1B/1D receptors. Two primary hypotheses has been proposed for their action- 1. Activation of 5HT1D/1B receptors on pre-synaptic trigeminal nerve endings to inhibit the release of vasodilating peptides and anti- seizure agents may suppress excessive firing of these nerve endings. 2.Vaso-constricting action of direct 5HT agonists ( triptans and ergot) may prevent vaso-dilation and stretching of pain nerve endings. DOC for prophylaxis of migraine is propranolol.
Buspirone
Ondansetron
Frovatriptan
Ketanserin
Histamine, 5-HT and PGs