Patient preference in migraine therapy. A randomized, open-label, crossover clinical trial of acute treatment of migraine with oral almotriptan and rizatriptan.

Objective: To assess patient preference for almotriptan 12.5 mg vs rizatriptan 10 mg for the acute treatment of migraine.

Methods: Randomized, multicenter, open-label, crossover trial in which triptan-naïve patients treated two moderate/severe migraine attacks, the first with one triptan and the second with the other: 183 patients took rizatriptan followed by almotriptan and 189 treated in the reverse order. Patient preference was assessed with a self-administered questionnaire.

Results: Of those recording a preference (209), 54.5% preferred almotriptan, but statistical significance was not achieved. The main reason for preference for one or the other triptan was efficacy: 43% of patients preferring almotriptan gave faster headache relief as the reason and 34% cited faster return to normal activities. The corresponding values for rizatriptan were 47% and 38%. A significantly greater proportion of those preferring almotriptan cited fewer adverse events (AEs) as the reason. Almotriptan and rizatriptan were of comparable efficacy and both treatments were well tolerated; 9% of patients experienced AEs probably or possibly related to study medication after almotriptan vs 14% after rizatriptan. Almotriptan was associated with a significantly lower incidence of triptan-associated AEs in triptan-naïve patients (8.5% vs 18% with rizatriptan).

Conclusion: Physicians should use information from meta-analyses and preference studies like this one to aid in the selection of a triptan with a high likelihood of providing rapid, sustained relief from pain coupled with an absence of AEs. About 55% of patients recording a preference in this trial preferred almotriptan, perhaps because of its combination of good efficacy and lower incidence of triptan-associated AEs.