Acute treatment of migraine and the role of triptans.
The use of triptans has improved the ability to treat migraine successfully compared with older treatments. Speed of relief, consistency of effect, and good tolerability have been the hallmarks of these agents. All of the currently available triptans have comparable efficacy and tolerability. Variables between the agents may lead to one agent or dose form being preferred over another in various clinical scenarios. The triptans that are forthcoming may improve on these options through enhanced efficacy rates, tolerability, and headache recurrence rates. There exist increasing options for migraine treatment that may further improve the clinical effects of the older and newer triptans through early treatment of migraine at the stages of mild migraine pain, or even during the prodromal phase of the attack. Additionally, recent work suggests that mini-prophylaxis of migraine at the menses is a highly successful treatment option with the triptans. In this age of managed care, providing cost-effective treatment of headache will take on increasing importance. Techniques such as stratification of acute treatments may enhance cost-effective care, whereas ready availability of the triptans may lead to significant improvements in utilization of parameters such as office visits, emergency room treatment, and even hospitalization.
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Diamond Headache Clinic, 467 W. Deming Place, Suite 500, Chicago, IL 60614, USA. dhcdoc@aol.com
D000208:Acute Disease; D001783:Blood Flow Velocity / Q000187:drug effects; D002227:Carbazoles / Q000008:administration & dosage / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004333:Drug Administration Routes; D005260:Female; D006801:Humans; D007211:Indoles / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008598:Menstruation; D008881:Migraine Disorders / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control; D023303:Oxazolidinones / Q000008:administration & dosage / Q000627:therapeutic use; D010880:Piperidines / Q000008:administration & dosage / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011759:Pyrrolidines / Q000008:administration & dosage / Q000627:therapeutic use; D044302:Receptor, Serotonin, 5-HT1B; D044346:Receptor, Serotonin, 5-HT1D; D011985:Receptors, Serotonin / Q000187:drug effects; D017366:Serotonin Receptor Agonists / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D018170:Sumatriptan / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage / Q000627:therapeutic use; D014363:Tryptamines; D014661:Vasoconstriction / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*
D002227:Carbazoles; C470302:HTR1B protein, human; D007211:Indoles; D023303:Oxazolidinones; D010880:Piperidines; D011759:Pyrrolidines; D044302:Receptor, Serotonin, 5-HT1B; D044346:Receptor, Serotonin, 5-HT1D; D011985:Receptors, Serotonin; D017366:Serotonin Receptor Agonists; D014230:Triazoles; D014363:Tryptamines; D014662:Vasoconstrictor Agents; C409045:almotriptan; C115647:eletriptan; C089750:zolmitriptan; C093622:rizatriptan; D018170:Sumatriptan; C108128:frovatriptan; C106783:naratriptan