In general practice, triptan overuse does not increase the risk of ischemic complications. Overuse of ergotamine may increase the risk of these complications, especially in those simultaneously using cardiovascular drugs.

This study aims to investigate usage patterns of specific migraine prophylactic medications in ergotamine and triptan patients commencing this treatment for the first time during 1 January 1992 until 31 December 1998. Usage patterns of specific migraine prophylactic drugs were evaluated for each patient by accessing data from a large prescription database and were characterized as continued, switch or stop use during the patient observation period. Several patient and medication-related factors were explored in order to identify a possible relationship with the specific usage pattern defined. Approximately 75% of the study population (n = 729) had terminated (stop or switch) prophylactic treatment after 1 year. Age < 40 years (relative risk (RR) 1.9; 95% confidence interval (CI) 1.2-3.2) and the concomitant use of non-steroidal anti-inflammatory drugs (RR 3.2; 95% CI 1.2-5.5) or specific abortive migraine drugs resulted in a faster onset of treatment modification (switch). Overall, migraine prophylactic treatment is used for a relatively short period, probably attributable to the common limitations associated with migraine prophylaxis, such as poor compliance and/or limited therapeutic efficacy. Patterns of use can be influenced by a variety of factors, including age, type of prescriber and certain co-medication. Patient interview studies are required to clarify these issues further.

Conclusions.-Single use of a sumatriptan prescription reveals some issues that may impact negatively the provision of effective migraine management. These include: rapidly developing dissatisfaction with the treatment provided and a lower tendency to seek out medical care. Our results also suggest that the drug may be used (inappropriately) as a diagnostic tool.Key words: migraine, sumatriptan, single recipient, inefficacy, diagnosis, consultation Abbreviations: OTC over the counter, DDDs defined daily doses, NSAIDs nonsteroidal antiinflammatory drugs ( Headache 2003;43:109-116) Due to increasing therapeutic options available for acute migraine management, physicians are currently able to achieve better clinical outcomes based on the individual needs of the migraineur. 1,2 In order to realize these goals, it is essential to acquire knowledge concerning patients' perceptions of and experiences with therapy and to obtain an accurate history of the headache after having established a diagnosis of migraine. 3 However, due to the relatively poor medical consultation rates observed within the migraine population in particular, the attempt to individualize and optimize migraine treatment is often weakened. 4,5