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Expert Rev Neurother. 2010 Sep;10(9):1399-408. doi: 10.1586/ern.10.119.

Influence of trigger factors on the efficacy of almotriptan as early intervention for the treatment of acute migraine in a primary care setting: the START study.

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  • 1Pain Neuromodulation Unit, Department of Neurology, Headache Center, Carlo Besta Neurological Institute Foundation, via Celoria 11, Milan, Italy.

Erratum in

  • Expert Rev Neurother. 2011 Feb;11(2):326.


In a large observational general practice study (the Standardized Study with Almotriptan in Early Treatment of Migraine [START]), 12.5 mg almotriptan administered within 1 h of pain onset and when pain was mild significantly improved pain-related outcomes, compared with later treatment or when pain was more severe. Migraine triggers at baseline and during treatment were recorded, and it was examined whether trigger factors could affect almotriptan-induced headache improvement. More than 400 patients were enrolled, and 1174 attacks were assessed. At baseline, patients reported a mean of 2.6 types of triggers related to the start of their previous migraine attacks. During the trial, a mean of 1.5 trigger factors for each attack was recorded. The most frequent trigger during the study was stress (37% of migraine attacks), with poor sleep (34%), fatigue (32%) and menses (19%) also being widely reported. Stress and fatigue and/or poor sleep were the most frequent trigger combinations. Early treatment with almotriptan improved clinical outcomes, regardless of the trigger factors involved. Similar results were observed for nonearly administration, although this was less efficacious than early intervention. An exception in the nonearly group was that migraines triggered by poor sleep had better responses than attacks in which sleep disorder was not a factor. Almotriptan maintained its efficacy irrespective of trigger factors in migraine patients treated in everyday clinical practice and, as shown in other studies, it was most effective in reducing pain-free rates when administered early, when pain was still mild.

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