Answer #8 - The newest thing for migraine is the Triptans in general. The Triptans were introduced to the migraine market in 1990 and it started with Imitrex or Sumatriptan, and this changed the face of migraine treatment in the last 15 years.

Since then we have had other launches with other Triptans which have included: Naratriptan or Imer

ge, Zolmatritan or Zomig, Rizatriptan or Maxalt, Elitriptan or Relpax, and Elmatriptan or Axert. The most recent on the block has been Relpax or Elmatriptan. The Triptans in general are what we call migraine specific medications, they basically block serotonin and they prevent the headache from progressing. The stop the dilation, they stop the inflammation at the blood vessel level and they prevent the headache from progressing to a point where they have a severe throbbing pain that we discussed earlier. Basically we changed the face of migraine in the last 15 years.

There are certain contraindications, in other words people who cannot take the Triptans. These are patients that have cardiovascular or heart disease or angina. Patients who have severe high blood pressure and certain one of the Triptans cannot be taken with certain medications and out patients would have to check with their physicians. All of these medications work about the same. If patients have been tried on one or two, they really should be tried on others if they have not been effective because there is certain evidence that shows that if patients have been tried on one of the Triptans and it hasn’t worked, they may respond very well to another Triptan so by all means if patients haven’t had a successful trial with one medication, they should be encouraged to try another one.

The most important point with these medications really is what we call formulation. In other words, some of these medications come in tablet; some come in a melt or a wafer. Some of them come in a nasal spray and one of them comes in an injectible. So for the patients point of view, if a patient has for example a severe nausea and vomiting and they can’t keep their pills down, then they should be considered for the nasal spray or the injectible which bypasses the gastric route.

If a patient has a headache that really escalates very quickly to the point where their headache is maximum within a half hour then they should be considered for one of the drugs that works very quickly, for example. If a patient has a headache that lasts a very very long time, for day or a day and a half such as the menstrual migraines the physician may choose one of the drugs that has a longer life for example. But these are all minor differences in the drugs.

One of the newest drugs which has been launched is Relpax, or Elitriptan. The Elitriptan has a longer life than the other medications, Naratriptan or Imerge also has a longer life. The Relpax or Elitriptan works a little faster, lasts a little longer so it may be a good alternative for example for someone who headaches tend to come a little faster and last longer and it’s a fairly gentle one that is fairly well tolerated as well. So there are different choices and these are just examples that the physician may use and patients can certainly go to their Dr. and look at these options with their physician.