"Mixing triptans": patient satisfaction

Although some patients may prefer using an oral triptan other than sumatriptan and injectable sumatriptan to treat an attack of persistent migraine, administration of 2 different triptans within a 24-hour period currently is contradicted.

We sought to determine patient satisfaction with an acute migraine treatment regimen wherein patients were permitted to administer an oral triptan other than sumatriptan and injectable sumatriptan within 24 hours of one another

We evaluated a consecutive series of migraine patients who either had tried and failed oral sumatriptan or were using another oral triptan and were satisfied with it. We advised subjects that they could administer their oral triptan and injectable sumatriptan within a single 24-hour period (but not within 2 hours of one another); we termed such treatment "mixing triptans." We asked all subjects to keep detailed written headache diaries for the 6-month treatment period, and at the 6-month end-of-study visit we asked subjects who had treated at least 3 migraine attacks by mixing triptans to rate their satisfaction with that treatment according to a 5-point Likert scale.

Of the 200 subjects enrolled, 132 (66%) used an oral triptan other than sumatriptan and injectable sumatriptan within a 24-hour period on at least 3 occasions. At their final follow-up visits, 117 (89%) of the 132 reported themselves "very satisfied" or "satisfied" with this specific treatment regimen. No serious adverse events were recorded.

The option of sequentially using an oral triptan other than sumatriptan and injectable sumatriptan to treat a given attack of migraine appears to correlate with a high rate of patient satisfaction. While in our subject population this treatment regimen was well tolerated, our study results do not suffice to establish the safety of "mixing triptans."