The efficacy of oral sumatriptan 100 mg in 61 patients with acute migraine was assessed in a double blind, randomized, placebo-controlled, crossover study at the Department of Neurology, The Prince Henry and Prince of Wales Hospitals, Sydney, and Austin Hospital and Repatriation General Hospital, Melbourne, Australia. The International Headache Society guidelines were used in diagnosis. The youngest patients were 18 years (mean 39 years) and all had 1 to 6 migraine attacks with or without aura per month for at least one year. Current prophylactic treatment was continued during the trial in 30% of the 47 patients analyzed. The response rate was significantly greater with sumatriptan than with placebo, 51% vs 10%. Rescue medication was needed at two hours in 41% and 88%, respectively. Of 28 patients who were headache-free at 2 hours after sumatriptan, 11 (39%) had a recurrence of headache within 24 hours. A tight feeling or tingling sensation in the head were the commonest side effects. [1]

COMMENT. Sumatriptan is a 5-hydroxytryptamine agonist found superior to ergotamine in a previous multi-national study (Eur Neurol 1991; 31:314-22). Trials in children are under consideration and FDA approval is in progress.

The International Headache Society guidelines for diagnosis of migraine used in the above study are complex and have not been widely adopted in clinical practice. Diagnostic criteria for practicing physicians are proposed by Solomon S and Lipton RB [2]. The criteria proposed for office diagnosis of migraine without aura (common migraine) are as follows (any two of the four features): (1) headache - unilateral; (2) headache - pulsating quality; (3) associated nausea; (4) associated photophobia or phonophobia. If preceded within one hour by visual, sensory, or motor symptoms lasting 5 to 60 minutes the headaches are diagnosed as migraine with aura (classical migraine). Organic disease must be ruled out and the patient should have had several similar attacks in the past. Tension type headache is usually diagnosed by negative criteria and by ruling out migraine, cluster headache and headaches due to organic disease. Cluster headaches are differentiated from migraine by the frequency of attacks (daily) and the associated autonomic symptoms (ipsilateral conjunctival injection, tearing, nasal congestion, ptosis or miosis).