Pathways to the best fit of triptans for migraine patients

Variability in drug response is a major barrier to the successful treatment of migraine, and most treatments are only optimal in a subset of patients. Although triptans provide the best therapeutic option for the treatment of acute migraine, it has not previously been possible to predict how well patients will respond to a specific triptan or whether they will experience unpleasant adverse events. Hence, it has been difficult for physicians to match individual patients with the most suitable agent to treat their migraine pain. Intrapatient variability has been associated with polymorphisms in genes encoding drug-metabolizing enzymes, drug transporters and drug targets. Pharmacogenetics provides the possibility of tailoring the therapeutic approach to individual patients, in order to maximize treatment efficacy while minimizing the potential for unwanted side-effects. This review demonstrates how almotriptan may overcome genetically determined responses by utilizing diverse metabolic pathways to provide therapeutic benefit to many migraineurs.