Serotonin syndrome
SCOTTSDALE, Oct 27 (Reuters Health) - The serotonin syndrome, which can be induced by several medications commonly used to control migraine, may be more common in migraine patients than is believed, according to Dr. Gretchen Tietjen, of the Medical College of Ohio, in Toledo. Dr. Tietjen spoke on the syndrome, which has only recently been recognized and reported in this population, at the American Association for the Study of Headache's Scottsdale Headache Symposium. "This is something that had been for many years primarily in the psychiatric literature," the researcher explained. However, she believes that the syndrome, caused by drug-induced central serotonergic hyperstimulation, "...can explain many of the symptoms we see in migraine patients." Serotonin syndrome is marked usually by mild and moderate motor symptoms, mental status changes and autonomic symptoms, such as weakness, fever, nausea, confusion and anxiety. Rarely, the syndrome is associated with severe complications, which can include stroke, seizure, Babinski signs and even death. The syndrome can be caused by any agent that "...enhance[s] serotonin availability at the neuronal synapse," Dr. Tietjen explained in a meeting abstract. These drugs include serotonin agonists, agents that reduce serotonin reuptake or breakdown, and drugs that enhance presynaptic release of serotonin. Although several of the affected patients Dr. Tietjen discussed at the meeting had been using sumatriptan, she believes that this drug was not a cause of serotonin syndrome since removing the patients' other medications resulted in resolution of symptoms. The first steps in diagnosing serotonin syndrome should be to rule out a biologic cause and to determine that the patient did not recently initiate treatment with a neuroleptic, according to Dr. Tietjen. In addition, the patient must have at least three symptoms specific to the disorder, usually beginning within hours of starting or increasing the dosage of a known serotonergic agent. Withdrawal of the causative agent or agents is the first step in treatment. Generally, symptoms will resolve quickly. In some cases, patients may require supportive therapy or treatment with a serotonin receptor antagonist. In extreme cases, intensive care with mechanical ventilation and muscle paralysis may be needed. Because the serotonin syndrome is most often mild and self-limiting in migraine patients, Dr. Tietjen told meeting attendees, she suspects that it often goes unrecognized and, therefore, may be more common than believed. Copyright © 1999 Reuters Ltd. All rights reserved. Republication or redistribution of Reuters content is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. -