Part I: what do patients really need and want from migraine treatment?

Migraine is characterised by recurrent episodes of head pain, often accompanied by other symptoms, such as nausea and vomiting. In addition to migraine impairing a patient's ability to function normally during an attack, fear of the next attack can detract from quality of life between attacks. Of those migraineurs who consult a physician for headache, the minority are prescribed migraine-specific triptans and many are dissatisfied with current therapy. Clinical trials have shown that triptans are capable of providing rapid and effective relief of headache pain, which is what patients primarily desire from acute migraine therapies. Patients generally prefer to administer acute migraine therapies orally, but conventional tablets do not suit all patients and situations. Some patients dislike swallowing tablets, nausea can make swallowing difficult and can be exacerbated by fluid intake, and attacks can easily strike when fluids are not readily available, especially as many young migraineurs lead busy, active lives. Patients need a treatment that enables any migraine attack to be treated promptly and effectively in any given situation. Tablets that dissolve rapidly on the tongue without a requirement for extra fluid intake are a popular alternative to conventional tablets, allowing discreet, convenient and early treatment of migraine anywhere and anytime it strikes. Several triptans are currently on the market in conventional tablet form, but some are available in other formulations, such as orally disintegrating tablets or nasal sprays, making it possible to prescribe rapidly effective migraine treatments in formulations that suit individual patient preferences, lifestyles and attack characteristics.