As a matter of fact, we now know that both vasoconstriction and vasodilation may be a part of a migraine attack – or perhaps may not be involved at all.
Vasoconstriction and vasodilation of course refer to blood vessels. They constrict (get smaller) and dilate (get larger) to control blood flow – you can think of them as pipes in your home, but “smart” pipes.
Back in the day we believed that migraine happened when blood vessels dilated – therefore we looked for medications that would constrict them.
Although some of these medications and treatments worked (somewhat), we now believe that many of them work for different reasons. Triptans are a classic example – though they do have a vasoconstriction effect, researchers now believe that this is not why they relieve migraine symptoms.
In fact, today researchers are looking for drugs that are not vasoconstrictors. Why? Because of concerns that constricting the blood vessels will lead to more heart attacks and strokes.
Some heart problems have been reported by people taking drugs such as triptans. On the other hand, some studies have suggested that there’s generally no connection.
Many doctors are reluctant to prescribe triptans or other vasoconstrictors to patients who are at a high risk of heart disease. And there is evidence that migraineurs in general are at a higher risk than the general population.
On of the drugs being researched is Lasmiditan, which is not a triptan but a ditan. Like triptans, it would be taken for a specific migraine attack, but without the potential dangers of vasoconstrictors.
We can hope that more and more treatments will be available that can stop a migraine attack without unnecessary side effects and dangers. Meanwhile, specialists are increasingly cautious about prescribing too many vasoconstrictors for migraine when there are other options.