Assessment of the efficacy and tolerability of triptans in clinical practice

In most cases a triptan is prescribed to a patient suffering from migraine who has been taking OTCAs for years, alone or combined with caffeine, antiemetics, barbiturates, etc. A proper use of triptans is therefore indispensable to correctly assess whether they are efficacious and/or toxic in a completely different setting from the one in which controlled clinical trials are conducted. Patient’s judgments on the treatment are therefore fundamental to assess if it is ineffective and/or causes toxic effects. The physician knows that the efficacy and toxicity among triptans are similar in clinical practice and that the response is individual and closely connected to the patient’s compliance and expectations. Most side effects of triptans appear the first time they are taken and their efficacy is rarely the same each time they are taken. It is therefore advisable to agree with the patient upon the use of the triptans: triptans are indispensable drugs to treat migraine, but they are not miraculous. To prevent the patient from stopping treatment or from trying different triptans and then returning to self-medication, the patient must agree to fill out a form on the efficacy and toxicity of the drug being taken. Naturally, before preparing this form, the physician has to decide whether to use the same parameters of efficacy and tolerability in clinical practice and controlled clinical trials. Whatever instruments are used to assess the drug, there are some key elements to consider: time when the migraine attack started; time when the drug was taken; presence of autonomic symptoms or aura; intensity of the pain when it started and at the moment when the drug was taken; duration of attack; should there be any relapse, at what time it appeared; should there be any side effects, their intensity and duration. The information gathered must then be discussed with the patient to decide whether to continue or modify the treatment. Data on the efficacy and tolerability of triptans, also if combined with other drugs, could help to identify sub-groups of patients suffering from migraine who are non-responders to triptans and/or prone to toxic effects.