Match migraine pharmacology to comorbidity and safety constraints, especially when considering ergots, and counsel clearly about fibrosis risk, serotonin-related interactions, and vasoconstrictive versus non-vasoconstrictive options.

Serotonergic neurons relevant to migraine are concentrated in the raphe nuclei; Triptans and ergots act mainly through 5-HT1B and 5-HT1D agonism; Chronic ergot exposure can cause serious fibrotic complications; Several preventive agents reduce trigeminal activation by modulating serotonin pathways; Some newer migraine therapies avoid vasoconstriction but introduce different safety issues