Sumatriptan (IMITREX®, Galaxo-Wellcome) was introduced in 1993 for the acute treatment of migraine. Since then other triptans have been introduced including: naratriptan (AMERGE®, Galaxo-Wellcome); zolmitriptan (ZOMIG®, Zeneca); and rizatriptan (MAXALT ®, Merck). These agents are selective 5-HT1 receptor agonists. Cady et al{226} found that sumatriptan (6mg SC) was more effective than placebo in reducing moderate or severe pain to mild or no pain (70% vs 22%) and in completely relieving pain (49% vs 9%) after 1 hour. These agents are now the most widely used acute abortive agents.{207} The efficacy of oral sumatriptan in a 100mg dosage is comparable with that of the subcutaneous injection but the onset of treatment effects longer.{208,227} The initial starting dose is of oral sumatriptan is 25mg taken with fluids. The maximum recommended single dose is 100mg. If a satisfactory response is not obtained in two hours, a second dose of up to 100mg may be given. If headache returns, additional doses may be taken at intervals of at least two hours up to a maximum daily dosage of 300mg.{208-211} Specific contraindications to the use of sumatriptan include ischemic heart disease, Prinzmetal's angina, and vertebrobasilar migraine. Side effects include pain at the injection site, tingling, flushing, burning, and warm or hot sensations. Dizziness, heaviness, neck pain, and dysphoria can occur. These side effects generally abate within 45 minutes. A review of the dosing of triptans and comparative 'street' prices is found in the Medical Letter