Triptans: the experience of a clinical pharmacologist in clinical practice

Despite the pharmacokinetic differences among triptans and the variety of ways of administration, the clinical differences in every day use of these drugs lack in an accepted decisional tree. In fact, there are a number of comparative trials showing conflicting results with regard to efficacy, onset of action, safety and recurrence incidence. That means that the patient’s preference probably is the main criterion for choosing one triptan vs. others. This point of view is probably correct considering also that the main cause of therapy failure is noncompliance. A good migraine care strategy requires a balance in what the patient views as satisfactory, a reasonable compromise between efficacy and tolerability, and a careful follow–up. Improvement in compliance should be the main and more immediate goal for the treatment of migraine attacks.