Cost and access aside, when might you prefer to start a patient on a triptan instead of a gepant for acute migraine therapy?

For me, the triptans are first line for migraine abortion. They have been on the market for well over three decades, we have a lot of experience with them, a lot of clinical-trial information is available on them, and also in special populations like teenagers and adolescents, as well as pregnant wo...

Cost aside, I would prescribe gepants before triptans for the acute treatment of migraine for the following reasons:

1. Gepants have favorable tolerability profiles.
2. Gepants have favorable safety profiles, particularly in people with cardiovascular contraindications and precautions for triptans.
3. Tripta...

No doubt, the triptans remain the best abortive medications to treat acute migraine. They have to be taken at the onset, no delay. I will NOT prescribe a gepant as first-line unless there are reasons: the patient has tried at least two different triptans correctly several times with no response, and...

Every patient should be started first on an oral triptan for the acute treatment of migraine, as they work, usually do not cause significant AEs, are easy to get, and are not expensive comparatively. They could also be started on a fixed dose combination of MOSEIC meloxacam and rizatriptan or a subc...