Triptan Therapy in Migraine

An otherwise healthy 23-year-old woman presents to her internist with a report of headaches and associated symptoms that occur twice a month. A diagnosis of migraine without aura is made. The patient's headaches last up to a day and cause her to miss work. The headaches have not responded reliably to analgesics or to combinations of analgesics with caffeine. Her internist has previously recommended the combination of aspirin and metoclopramide, which usually diminishes but does not eliminate her headache pain. On one occasion, her headache progressed despite treatment, and the patient went to the emergency department. She received subcutaneous sumatriptan for a presumptive diagnosis of migraine. Her headache and nausea resolved, but she had a sensation of mild chest pressure for about 5 minutes, without associated symptoms. Her internist refers her to a headache specialist with the question of what therapy should be used to treat her headache episodes.