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migraine, drug resistance, triptans
The triptans are the first-line treatment for the symptomatic treatment of migraine of moderate and severe intensity. Despite their good risk/benefit profile, a third of patients treated with these drugs appears to be partially or completely non-responsive to a specific triptan. The main reasons for poor response to triptans include incorrect use of the drug (taking the wrong dosage or taking the drug at the wrong time), overuse of the drug and/or incomplete absorption of the molecule. Even though all the triptans currently on the market share the same mechanism of action, a partial response or no response to a specific triptan does not appear to be predictive of therapeutic ineffectiveness to another molecule belonging to the same class. It is in fact known that migraine attacks can be resolved by switching from a triptan that has proved ineffective to another triptan. Alternative treatments effective in the symptomatic treatment of migraine in triptan non-responders are the following: i) ergotamines, specifically dihydroergotamine, indicated for the symptomatic treatment of migraine (including menstrual migraine) attacks, and ii) some nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, naproxen sodium, ibuprofen, diclofenac and ketorolac, effective in resolving non-disabling migraine of mild/moderate severity. The effectiveness of the symptomatic therapy being used, whatever it is, should be monitored over time by having the patient keep a detailed headache diary in which he/she records, for each migraine attack, the migraine therapy taken and the response obtained. Complete information, carefully recorded in the diary, can be useful, enabling the specialist to assess the efficacy of the treatment in terms of reduction/disappearance of the pain sensation, resolution of the accompanying symptoms, intake of the prescribed drug/drugs, and introduction of rescue medication should the first-choice drug prove ineffective.