A study of the effects of sumatriptan on myocardial perfusion in healthy female migraineurs using 13NH3 positron emission tomography

Sumatriptan, a 5-HT1D receptor agonist, is believed to alleviate migraine attacks by extracerebral vasoconstriction. Chest pain associated with myocardial ischemia may occur after sumatriptan administration. We investigated the effect of a single 6-mg subcutaneous dose of sumatriptan on myocardial perfusion (MP) as measured by (NH3)-N-13 positron emission tomography (PET) in a randomized double-blind, placebo-controlled, crossover trial at the Clinical PET Centre, Guy's and St. Thomas' Hospitals, London. Nineteen volunteer female migraineurs, age range 33 to 62 years, at low risk for ischemic heart disease were included. All had undergone previous treatment with oral or intravenous sumatriptan. Patients were recruited by advertisement and referral from local neurology specialists. Each volunteer underwent two scanning sessions. On each occasion, a baseline dynamic (NH3)-N-13 PET scan was acquired followed by a (NH3)-N-13, PET scan 10 minutes after subcutaneous injection of placebo or 6 mg of sumatriptan. Regional MP was measured in five myocardial regions using the Patlak system of image analysis. The mean % change from baseline (+/-SD) in global MP after placebo was +9.5% +/- 18.0 and after sumatriptan was +6.6% +/- 18.8 (repeated measures ANOVA for treatment effect p = 0.56). There were no significant differences in MP changes from baseline observed in any of the five myocardial regions (treatment p = 0.32 to 0.84). These data suggest that in healthy female migraineurs, a single 6-mg subcutaneous dose of sumatriptan does not cause a significant change in regional or global myocardial perfusion.