Abstract
Abstract The estimated prevalence of headaches in the population is 66%. According to recent guidelines, basic analgesics, nonsteroidal anti–inflammatory drugs (NSAIDs), or acetaminophen are frequently used as first–line treatment for mild migraine attacks. A triptan is added when analgesic–resistant attacks occur. So these drugs are used as a second–line medication for mild migraines and a first–line medication for moderate to severe headaches. A correlation between spontaneous coronary artery dissection (SCAD) and triptans has already been reported in the literature. If myocardial infarction is more common in patients with cardiovascular risk factors, SCAD seems more frequent in young and smoker females. What is interesting is the speculation of the pathophysiological mechanisms of SCAD after triptans use. A possible option may consist in the fact that the dissection of the anterior descending artery is due to circumferential shear stress caused by these drugs, combined with smoking habits and estrogen deprivation. These latters influence the immune system and the circulating progenitor cells, which are reduced and less active to replace senescent endothelial cells. That is why an intimal flap is formed so that the blood would enter the media and the dissection would be perpetuated. The suspension of the drug is necessary to prevent the vasoconstriction of the vessel from exacerbating the wall stress caused by smoke and sexual hormones deficiency.
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