Individual Triptan Selection in Migraine Attack Therapy

Abstract

About 6% of men and 18% of women suffer migraine attacks. Migraine can induce a great impact in the quality of life of the patient and the costs of medical care and lost productivity can be also high. There are two therapeutic approaches in the treatment of migraine: preventive therapy and acute treatment of migraine attack. Immediate treatment with selective serotonin [5-HT1B/1T] receptor agonists (so-called triptans) is the first-line option in the acute treatment of moderate-severe migraine attacks. The introduction in early nineties of triptans was a revolution in migraine therapy and evidences about their efficacy are at present irrefutable. At the moment, there are seven marketed molecules: sumatriptan, rizatriptan, zolmitriptan, eletriptan, naratriptan, almotriptan and frovatriptan. Obviously, every molecule has different pharmacokinetic and pharmacodinamic properties and, moreover, some triptans have several formulations: tablets, dissolvable tablets, nasal and injections. The prescription of one of these seven triptans for a specified patient is based in the drug profile: efficacy, safety, pharmacokinetics and pharmacodynamics. Despite there are a lot of published studies using triptans, no clinical trial has analyzed all the molecules at the same time. Other data to take account in the final prescription are clinical characteristics of the migraine attack and patient characteristics: labour aspects, style of life and the patient medical history. We present a state-of-the-art of the triptan selection in treatment of moderate-severe migraine attacks.