title: Improved patient satisfaction and pain evolution with almotriptan in migraine: a primary care study.
abstract: OBJECTIVE
  The START study was a large general practice observational study involving 400 patients with migraine. Given the large sample size, a sub-analysis was planned to ascertain whether any patient characteristics/behaviors might help predict/explain the responses observed in this study, which demonstrated that almotriptan administered early when pain was mild significantly improved pain-related outcomes compared with non-early/non-mild treatment.
  
  
  METHODS
  This pre-planned sub-analysis assessed the impact of predictors of patient satisfaction, medication history, delayed drug intake, etc. on the primary pain endpoints of the START study.
  
  
  RESULTS
  Patients had previously tried an average of 2.5 drugs for migraine relief and were currently taking a mean of 1.4 drugs. Almotriptan had been tried by 21% of the sample and was still being used by 83% of this sub-group. Treatment satisfaction was higher in the subset of patients taking almotriptan than in almotriptan-naїve individuals (p < 0.001) and this may explain why this group had the highest continuation rate of all drugs evaluated. On completion of the study, patient satisfaction was higher in the early/mild treatment group than the non-early/non-mild group (p = 0.049). Many patients delayed taking almotriptan, despite being instructed otherwise. Patients reported that this was primarily because they believed that they should only take the medication in the case of a severe migraine attack and/or to ensure that the symptoms were definitely due to migraine headache. The limitations of the trial include its open, observational design, and the small number of individuals who managed to treat their migraine attack within 1 hour when it was still mild.
  
  
  CONCLUSIONS
  Almotriptan was associated with increased patient satisfaction, particularly when taken early. Further action is required to increase patient compliance with early treatment regimens to improve clinical outcomes.
authors.affiliation: Hospital Francisco de Borja, Gandía, Spain. samueldiaz@ono.com
authors.forename: Samuel
authors.initials: S
authors.lastname: Díaz-Insa
authors.forename: Carlos
authors.initials: C
authors.lastname: Vila
authors.forename: Caroline C
authors.initials: CC
authors.lastname: McGown
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D018890:Chemoprevention / Q000379:methods / Q000706:statistics & numerical data; D018450:Disease Progression; D006801:Humans; D008881:Migraine Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011320:Primary Health Care; D011379:Prognosis; D014363:Tryptamines / Q000627:therapeutic use*
chemical_list: D000700:Analgesics; D014363:Tryptamines; C409045:almotriptan