title: Patient preference in migraine therapy. A randomized, open-label, crossover clinical trial of acute treatment of migraine with oral almotriptan and rizatriptan.
abstract: OBJECTIVE
  To assess patient preference for almotriptan 12.5 mg vs rizatriptan 10 mg for the acute treatment of migraine.
  
  
  METHODS
  Randomized, multicenter, open-label, crossover trial in which triptan-naïve patients treated two moderate/severe migraine attacks, the first with one triptan and the second with the other: 183 patients took rizatriptan followed by almotriptan and 189 treated in the reverse order. Patient preference was assessed with a self-administered questionnaire.
  
  
  RESULTS
  Of those recording a preference (209), 54.5% preferred almotriptan, but statistical significance was not achieved. The main reason for preference for one or the other triptan was efficacy: 43% of patients preferring almotriptan gave faster headache relief as the reason and 34% cited faster return to normal activities. The corresponding values for rizatriptan were 47% and 38%. A significantly greater proportion of those preferring almotriptan cited fewer adverse events (AEs) as the reason. Almotriptan and rizatriptan were of comparable efficacy and both treatments were well tolerated; 9% of patients experienced AEs probably or possibly related to study medication after almotriptan vs 14% after rizatriptan. Almotriptan was associated with a significantly lower incidence of triptan-associated AEs in triptan-naïve patients (8.5% vs 18% with rizatriptan).
  
  
  CONCLUSIONS
  Physicians should use information from meta-analyses and preference studies like this one to aid in the selection of a triptan with a high likelihood of providing rapid, sustained relief from pain coupled with an absence of AEs. About 55% of patients recording a preference in this trial preferred almotriptan, perhaps because of its combination of good efficacy and lower incidence of triptan-associated AEs.
authors.affiliation: Department of Neurology, Hospital General Yagüe, Avda. Del Cid 96, 09005 Burgos, Spain. iglesias@hgy.es
authors.forename: Fernando Iglesias
authors.initials: FI
authors.lastname: Díez
authors.forename: Andreas
authors.initials: A
authors.lastname: Straube
authors.forename: Giorgio
authors.initials: G
authors.lastname: Zanchin
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use*; D016037:Single-Blind Method; D013997:Time Factors; D014230:Triazoles / Q000627:therapeutic use*; D014363:Tryptamines / Q000627:therapeutic use*
chemical_list: D017366:Serotonin Receptor Agonists; D014230:Triazoles; D014363:Tryptamines; C409045:almotriptan; C093622:rizatriptan