Department of Pharmacology, The University of Arizona College of Medicine, Arizona, USA.
Curr Opin Support Palliat Care. 2014 Jun;8(2):137-42. doi: 10.1097/SPC.0000000000000044.
The serotonergic system has long been linked to migraine but recent studies highlight how much is still unclear about this link. And recent data add to the uncertainty of where/how triptans act and why they are headache specific.
Markers of 5HT levels in the brains of migraine patients show no changes between attacks. Several recent meta-analyses show the most convincing data on genetic differences in the serotonergic system for 5HT transporters. Findings of additional triptan actions on peripheral trigeminovascular neurons and in the hypothalamus add more fuel to the debate on where these drugs act. A growing list of studies show efficacy of multiple triptans and other 5HT1b/1d agonists in preclinical models of nonheadache pain arguing for reevaluation of whether these drugs have efficacy in other pain states. Despite these issues, serotonergic drugs continue to be the gold standard for abortive agents with new members on the horizon (5HT1f agonists).
Given the clear efficacy of serotonergic drugs for migraine, continued study on the role of the endogenous 5HT system may lead to more novel therapies. And with the list of studies demonstrating efficacy triptans in models of nonheadache, clinical studies should address whether these drugs work for other types of pain.
5-羟色胺（5-HT）能系统与偏头痛的关系由来已久，但最近的研究强调了人们对这种联系的认识仍有很多不清楚的地方。最近的数据增加了不确定性，即曲坦类药物的作用部位和作用机制，以及为何其对头痛具有特异性。
偏头痛患者大脑中 5-HT 水平的标志物在发作之间没有变化。几项最近的荟萃分析显示了 5-HT 转运体的 5-HT 能系统中遗传差异的最有说服力的数据。关于这些药物在周围三叉神经血管神经元和下丘脑中的其他作用的发现，为这些药物的作用部位的争论增添了更多的动力。越来越多的研究表明，多种曲坦类药物和其他 5-HT1b/1d 激动剂在非头痛疼痛的临床前模型中具有疗效，这使得人们重新评估这些药物在其他疼痛状态下的疗效。尽管存在这些问题，但 5-HT 能药物仍然是治疗偏头痛的金标准，新的成员（5-HT1f 激动剂）即将出现。
鉴于 5-HT 能药物对偏头痛的明确疗效，继续研究内源性 5-HT 系统的作用可能会带来更多新的治疗方法。随着一系列研究表明曲坦类药物在非头痛模型中具有疗效，临床研究应该解决这些药物是否对其他类型的疼痛有效。
