A variety of treatment attributes are important in determining the reasons involved in switching a triptan. To assess this attributes can provide additional information to supplement the traditional tests of efficacy provided by randomized clinical trials.

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Tinnitus is not a common auditory symptom in migraine. Recent research suggests that central sensitization (CS) develops in most migraneurs during the course of a migraine attack. Herein we describe 3 patients with primary headache disorders and tinnitus as their chief complaint, in whom the tinnitus intensity consistently increased during headache attacks. In headache patients, tinnitus may be related to spontaneous and aberrant neural activity at any level along the auditory axis, with abnormal reorganization processes in the auditory cortex following hearing receptor damage. We hypothesize that the tinnitus intensity increase could be an allodynic symptom related to CS, or alternatively could be associated with cortical hyperexcitability.

Naratriptan may have a role in the preventive treatment of intractable chronic migraine. Prospective, controlled studies should be considered.