Ditans (Ditans) for Migraine:

• Mechanism: Ditans (ditans) are a new class of acute migraine treatments that act as 5-HT1F receptor agonists. Unlike triptans, which target 5-HT1B/1D receptors, ditans selectively activate 5-HT1F, reducing vasodilation and neurogenic inflammation without significant vasoconstriction.
• Key Agents:
  • Lasmiditan (approved in 2019) – oral, non-vasoconstrictor, effective for moderate-to-severe migraine attacks.
  • Rimegepant (approved in 2020) – oral, also a CGRP antagonist (dual mechanism), used for acute and preventive treatment.
• Advantages:
  • No vasoconstrictive effects → safer for patients with cardiovascular risk factors.
  • Rimegepant has a preventive role (Lancet Neurol 2020; 19:727).
• Limitations:
  • Lasmiditan: CNS side effects (dizziness, paresthesia) in ~20%.
  • Rimegepant: mild side effects (nausea, constipation) in ~5%.
• Guidelines: AAN (2021) supports ditans as an option for acute migraine, especially in triptan-intolerant patients.

Rationale: Ditans offer a safer alternative to triptans for patients with cardiovascular comorbidities, with lasmiditan and rimegepant being the two approved agents. Rimegepant’s dual mechanism may also benefit preventive therapy.