Clinical applications of new therapeutic deliveries in migraine

A number of serotonin (5-HT)(1B/1D) agonists (triptans) are available worldwide for the treatment of migraine. The first-generation triptan, sumatriptan, was initially launched as an SC injection, which is fast-acting and consistently effective but relatively expensive and can be associated with adverse events in some patients. Sumatriptan was then launched as an oral tablet, shortly followed by the development of second-generation triptans that are now available in several formulations. Tablets are highly effective and convenient but may not be suitable in all migraine situations, e.g., migraine-associated nausea or vomiting and gastric disturbances. An intranasal route of administration appears to be an obvious way to deliver a migraine treatment and two triptans, sumatriptan and zolmitriptan, are available in nasal spray formulations. Sumatriptan offered the first nasal spray and has similar efficacy to the sumatriptan tablet, but the response is inconsistent and many patients cannot tolerate the unpleasant taste. The latest nasal spray, zolmitriptan, has produced exciting results in clinical studies and combines a rapid onset of action and consistently high response rates with a good tolerability profile. Early results from the author's clinic suggest that this promise is realized in clinical practice and that this combination of patient benefits makes zolmitriptan nasal spray an ideal way for patients to treat their migraine. With the introduction of zolmitriptan nasal spray, zolmitriptan is now available in three different formulations, enabling patients to tailor their treatment to the circumstances of the individual attack.