Effect of sumatriptan on ATP-sensitive potassium channel opening in migraine: A randomised controlled trial

ObjectiveTo investigate whether early administration of sumatriptan prevents migraine induced by ATP-sensitive potassium (KATP) channel opener levcromakalim.MethodsThis single-centre, randomised, double-blind, placebo-controlled, two-way crossover study included adults with migraine without aura. Participants received a 20-minute intravenous infusion of levcromakalim on two separate occasions, followed immediately by a 10-minute intravenous infusion of either sumatriptan or placebo (isotonic saline) in a balanced allocation. The primary endpoint was the difference in the incidence of levcromakalim-induced migraine aftersumatriptan versus placebo over 12 hours. A secondary endpoint was the area under the curve (AUC) for headache intensity scores between experimental days.ResultsTwenty of 24 participants completed the study. The incidence of migraine induced by levcromakalim was 75% following sumatriptan and 85% following placebo (p = 0.69). The AUC for headache intensity scores showed no difference between sumatriptan and placebo days (p = 0.12). Post-hoc analyses correcting for intensity at 40 minutes post-levcromakalim revealed a significantly lower AUC for headache intensity following sumatriptan compared with placebo (p = 0.002).ConclusionsEarly sumatriptan treatment does not prevent migraine induced by KATP channel opening, suggesting that KATP-induced migraine occurs downstream of sumatriptan's site of action. However, sumatriptan reduces headache intensity, warranting further exploration of its modulatory effects.