the 5-HT1F receptor produces anti-nociception without the vasoconstriction induced by the 5-HT1B and 1D receptors targeted by triptans
Lasmiditan
is the only currently available medication in the ditan class and has been approved by both the FDA and EMA but has not been recommended by the National Institute for Health and Care Excellence (NICE) (1)
is a serotonin 5-HT1F receptor agonist that has been shown effective for acute migraine treatment (2)
has a higher incidence of side effects, including dizziness, fatigue, and sedation (1)
in a multicenter, double-blind, randomized controlled studies, between 25.4% to 39.0% of patients receiving lasmiditan reported adverse effects (3)
most adverse events were CNS-related and included dizziness, somnolence and paraesthesia
Lasmiditan was effective at 2 h post-dose for acute treatment of migraine at all oral doses tested.
patients should be counselled to avoid any activity requiring alertness, including driving, for at least eight hours after taking the drug
evidence suggests that gepants and lasmiditan are likely to be somewhat less effective than triptans
may be used in patients with cardiovascular contraindications to triptan use
Reference:
Burch R, Rittenberg E. New treatments for migraine: CGRP monoclonal antibodies, gepants, and ditansBMJ 2025; 390 :e085564
Lew C, Punnapuzha S. Migraine Medications. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
Goadsby PJ, Wietecha LA, Dennehy EB, Kuca B, Case MG, Aurora SK, Gaul C. Phase 3 randomized, placebo-controlled, double-blind study of lasmiditan for acute treatment of migraine. Brain. 2019 Jul 01;142(7):1894-1904
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