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How might one go about attacking this system to halt the to and fro volleys of escalating head pain signal? The options are vast and extend from the simplistic to the highly complex and specific. During an acute migraine, the afflicted individual instinctively may take steps to calm what essentially is an acutely agitated biologic system. A dark, quiet room and sleep may go a long ways towards bringing the migraine attack to a close; sleep in particular involves activity of serotonin, the neurochemical messenger that appears to play a major inhibitory role in the head pain pathway. Some find that aerobic exercise will abort an attack; others find exercise intolerable, experiencing with it a dramatic increase in the pain already present. Some have learned that ingestion of a caffeinated beverage will help quell an attack; others find that caffeine serves not only to trigger attacks but also to amplify migrainous pain once it is present.
Certain prescription and nonprescription drugs exert nonspecific or highly selective actions that may interrupt head pain transmission or at least nullify the effects of that transmission. Steroid medication and nonsteroidal anti-inflammatory drugs can be useful if taken early in an attack; their precise mechanism and site of action are unknown, but one possibility is that they counteract the meningeal inflammation produced by release of neuropeptide messengers3 at the junction of the trigeminal nerve endings and the blood vessels they supply.
Other, more selective agents have been synthesized to mimic naturally occurring brain chemicals that influence inhibitory switches located along the head pain circuit. If the agent can reach the inhibitory receptor and activate it, the transmission of head pain is effectively switched off. The triptan family, including its progenitor, sumatriptan (Imitrex), are “designer drugs” that resemble serotonin and have a selective affinity for these inhibitory switches.
It should be noted that a sizeable proportion of migraine sufferers experience headaches on a chronic, pervasive basis. Biologically, the head pain signaling system in these individuals has become chronically sensitized, and aggressive, persistent and consistent therapeutic intervention is required to desensitize those systems and restore them to a state that renders the individual headache free or nearly so. | 
