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Recent studies have delineated a clear role for the trigeminal innervation of pain-sensitive intracranial structures in the pathophysiology of migraine. The development of new compounds for the treatment of the acute attack of migraine has led to a greater understanding of serotonin (5-hydroxytryptamine; 5HT) receptor diversity. The ergot alkaloids have been used in the treatment of acute attacks of migraine for many years and parenteral administration of dihydroergotamine (DHE) can be a useful treatment strategy. In this study, the question of a possible central site of action of DHE is considered using both anatomical and physiological approaches. The c-Fos method has been used to map functional activation of central neurons in response to stimulation of the superior sagittal sinus (SSS) in the cat. This structure has been used as it refers pain to the ophthalmic division of the trigeminal nerve in humans, and in cats induces changes in neuropeptides and cranial blood flow similar to those seen in migraine. In addition, the temporal aspects of the effect of DHE have been studied by making extracellular recordings from cells in the most caudal aspect of the trigeminal nuclear complex. Stimulation of the SSS results in Fos expression in the superfical laminae of the trigeminal nucleus caudalis and in the dorsal horn of C1 and C2. This activation is blocked by a clinically relevant dose of DHE. Similarly, cells can be recorded in this region that respond to SSS stimulation. This linked cellular activity can be inhibited by the same intravenous dose of DHE. Together, these studies show that DHE can inhibit activity in central trigeminal neurons. Since the sinus and its nerve supply are directly stimulated, the peripheral nerve/vessel innervation is bypassed and this inhibition cannot have happened at any other site. These data imply that drugs acting at the central trigeminal neurons may have a role in the treatment of acute attacks of migraine.

Central activation of the trigeminovascular pathway in the cat is inhibited by dihydroergotamine