Dynamic Chiropractic – November 4, 2008, Vol. 26, Issue 23

dynamicchiropractic.com >> Headaches & Migraines

Imitrex (Sumatriptan Succinate)

By Daniel Hough, DC

The first article in this series, "Fosamax," appeared in the Aug. 26 issue.

These days, we are bombarded with advertisements for prescription drugs. Many of our patients are taking these drugs.

According to Fortune magazine, total 2007 revenue for the pharmaceutical industry was more than half a trillion dollars and its profits were more than $79 billion. As chiropractors, we need to be informed about these prescription drugs so we can educate our patients about their effects, side effects and dangers, as well as suggest safer alternatives when appropriate. (Don't count on their medical doctor or pharmacist to fully inform them.)

Imitrex is sold for the relief of the symptoms of migraine headaches. It doesn't cure anything; it is only palliative. Imitrex is available in three forms: injection, nasal spray or tablet. It is known as a 5-HT agonist and is a powerful vasoconstrictor. Other drugs in the same class as Imitrex include Amerge, Maxalt and Zomig. A generic version is not yet available.

Imitrex is manufactured by GlaxoSmithKline. In 2006, GSK's total sales from pharmaceuticals were approximately $45 billion.1 On Sept. 2, 2008, Mr. Dan Troy was appointed senior vice president and general council at Glaxo- SmithKline. Troy formerly served as chief council for the U.S. Food and Drug Administration. It appears GlaxoSmithKline and the FDA have a rather cozy relationship.2

CVS Pharmacy in Bozeman, Mont., where I practice, charges $28.89 for a single 50 mg tablet of Imitrex. Patients are advised to take up to 100 mg Imitrex per day. The Physicians' Desk Reference lists more than 100 adverse side effects from taking sumatriptan succinate, including: muscle weakness, serious heart problems, seizure, severe allergic reactions, anxiety, backflow of stomach contents, confusion, depression, joint pain, muscle pain, and, ironically, headaches.3

Vascular headaches are caused by the compromise of the postganglionic sympathetic nerves above the superior sympathetic ganglion. These nerves control, among other functions, blood vessel diameter in the cranium and function of the dilator pupilae muscles, which dilate the pupils of the eyes.

Subluxation of the atlas/occipital articulation compromises those nerves, causing them to fire.  This then causes vasoconstriction of the blood vessels in the head and dilation of the pupils, which explains the photophobia many migraine sufferers experience. The vasoconstriction eventually leads to hypoxia of the tissues surrounding the brain. Hypoxic tissues become acidic and release substance P, bradykinins and histamine, which causes vasodilatation and increased capillary permeability. The tissues in the skull are then flooded with fluid, causing the vascular headache.

Vascular headaches are divided into several types: common migraine, classic migraine, complicated migraine and cluster headaches. The etiology and chiropractic treatment is the same for all types.4 Treatment is safe and simple: adjustment of the C0/C1 cervical joint usually stops these headaches within minutes. Sometimes ergonomic changes are appropriate to avoid re-subluxation of the upper cervical spine. Over the years, I have noticed that patients who have recurring migraines are many times suffering from subclinical hypothyroidism. Referral for treatment of hypothyroidism with a preparation containing both thyroxine and triiodothyronine, if lab tests (T3 Free) so indicate, will allow the adjustment to hold and keep the headaches at bay with only an occasional adjustment.5


  1. GlaxoSmithKline. www.gsk.com/investors/presentations/2007/roundtable07/viehbacher roundtable07.
  2. www.biohealthinvestor.com/tag/glaxosmithkline.
  3. Sifton DW, et al. The PDR Pocket Guide to Prescription Drugs, 5th Edition. New York: Simon and Schuster, pp. 599-604.
  4. Hough D. "Cause and Treatment of Migraine Headaches." Dynamic Chiropractic, Nov. 1, 1999;17(23).
  5. Hough D. "What Every Chiropractor (and MD) Should Know About the Thyroid." Dynamic Chiropractic, April 7, 2003;21(8)

Dr. Daniel Hough is a 1991 graduate of Western States Chiropractic College. A former member of the Montana Chiropractic Association Ethics Committee, he practices in Bozeman, Mont.


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