[Clinical use of triptans in the management of migraine]

The discovery of the triptans (selective serotonin agonists 5HT(1B/1D), with 7 compounds (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan) soon available (5 in France: sumatriptan, naratriptan, eletriptan, zolmitriptan and almotriptan), was a considerable step forward in the acute treatment of migraine. Although randomized clinical studies have demonstrated their significant efficacy, triptans have still to be accepted into the clinical practice of some prescribing practitioners. Rather than attempting to highlight clinically insignificant differences between the triptans, efforts need to be focused on the optimal use of these drugs in clinical practice. This review therefore aims at answering questions related to the efficacy of triptans, recurrence of attacks after use, safety and tolerability, drug interactions and the cost of triptans in clinical use. Triptans are effective and well-tolerated drugs in the acute treatment of migraine attacks, and are the most cost-effective migraine therapy in patients with severe symptoms. Triptans should therefore be considered as first-line therapy in a stratified strategy, ensuring 'right treatment first time' for patients with severe migraine. Moreover, although very few studies have been conducted to date, clinical experience shows that a non-responder to one triptan may well benefit from another triptan, or even the same compound via a different route of administration.