Although
triptans represent the standard of care for
migraine that is severe, disabling and/or suboptimally responsive to
migraine non-specific
analgesia, they are often underused in clinical practice. Simple
analgesics and non-steroidal anti-inflammatory drugs (
NSAIDs) may provide effective treatment in some patients, but it is an inadequate response to these drugs that drives the therapeutic progression to
triptans at the end of the traditional 'step-care' approach. However, there are several disadvantages to this approach. It may cause patients to lose confidence in their physician during this hierarchical 'trial-and-error' search for optimal treatment when prescribed medications are ineffective, leading them to cease consulting before
triptans are tried. It may also result in a protracted time interval of suboptimal treatment, with unnecessary suffering in patients who are
triptan candidates. The alternative approach of 'stratified care', in which medication is prescribed according to the severity of symptoms, enables
triptans to be used earlier in the treatment plan, especially when
triptan candidates are given a choice between simple
analgesic/
NSAID and
triptan medication from the start. This raises the question about the efficacy of
triptans in
triptan-naïve (TN) patients. A recent exploratory post-hoc analysis compared the effect of
almotriptan 12.5 mg in TN patients (n = 342) with that in
triptan-experienced patients (n = 237).
Almotriptan was effective in both cohorts with a consistent trend in favour of the efficacy of
almotriptan in TN patients, notably for sustained
pain freedom (SPF) and SPF plus no adverse events. Moreover, both
headache recurrence at 24 h and the use of rescue medication was lower in the TN patients, whereas tolerability was equally good in both cohorts. These findings indicate that TN patients can expect excellent symptom control when they progress from non-specific
analgesia to treatment with
almotriptan and support the earlier use of
triptans in line with the stratified care paradigm.