Migraine is a common, chronic, neurovascular disorder characterized by recurrent attacks of headache and associated symptoms. Studies conducted around the world have consistently shown that migraine affects approximately 12–15% of the general adult population. This disorder is widespread across the world, mostly affecting young and middle-aged people, and is two-to three-times more common in women than in men [
1,
2]. Migraine patients differ in their management needs, largely due to the variation in severity of symptoms and their impact on the sufferer. Acute medications are needed by all migraineurs for symptomatic treatment and, for the majority of patients who have infrequent attacks, are the only therapy required. The migraine-specific medications that have become known as the triptans have revolutionized the acute treatment of migraine headache during the past 20 years. Triptans are the first-choice drugs for moderate-to-severe migraine attacks in all the management guidelines published in several countries, including the USA, UK, Italy, Canada, Germany and France. Triptans are selective 5-HT
1B and 5-HT
1D receptor agonists. Seven oral triptan formulations are now available for the treatment of migraine, each with its own characteristic strengths over a range of treatment attributes. Frovatriptan is the newest addition to the triptan class: its mean half-life is 26 h, the longest in the triptan group. The molecule was selected for development based upon its distinctive pharmacologic characteristics, which suggested that it would have the clinical potential for a long duration of action [
3‐
5], and a low likelihood of side effects [
6,
7] and drug interactions [
3,
4,
8,
9]. This therapeutic profile makes this triptan particularly suitable for treating patients whose migraine attacks last a long time, with an associated high risk of headache recurrence. In the new guidelines for controlled trials of drugs in migraine established by the International Headache Society (IHS), relapse (recurrence) is deemed to be a major problem with all effective migraine treatments and should be recorded as an important efficacy index [
10]. Recent trials have confirmed that frovatriptan has the lowest recurrence rate, when compared to other triptans [
6]. Moreover, due to its prolonged duration of action, frovatriptan provides a higher sustained pain response [
11‐
13]. Triptans have shown to be highly effective, well tolerated and the most cost-effective migraine therapy in patients with severe symptoms and disability [
14]. In head to head comparative trials the patients’ preference for one triptan or the other was not linked to pain-free rates. The drugs showed similar efficacy in the short-term, but frovatriptan seems to be unique in the triptan class, having the longest duration of action and the lowest recurrence rate [
7,
15,
16]. The good long-term efficacy of frovatriptan supports its indication for those patients requiring a prolonged duration of action, with a sustained effect and less side effects [
5‐
7,
15]. Rizatriptan is one of the most widely used triptans for the acute treatment of migraine. A systematic review and meta-analysis of the available triptans conducted in 2001, evaluating 53 double-blind, randomized, placebo-controlled trials, showed rizatriptan to be associated with the highest 2-h pain-free rates [
17]. Rizatriptan is rapidly absorbed after oral administration; the bioavailability is approximately 40-45% and Tmax is about 1–1.5 hours [
18].
The costs due to migraine (episodic and chronic) have been reported in several papers. The impact of migraine is a problem of enormous proportion, both for individual subjects and society [
19]. The total indirect costs were calculated to be 1.1 billion $ per year in the US and more than 3 billion € per year in Europe [
20‐
24]. Comparisons between triptan treatments, in terms of the cost to treat a single attack, were appraised in some European Countries. Whereas in France no difference between cost-efficacy of rizatriptan and frovatriptan was noted, in other three European Countries (Italy, Germany and UK) frovatriptan was shown to be associated with a lower cost per attack, with a significantly lower intake of rescue medications in the 24 hours following the triptan first dose [
25‐
28]. The aim of this study was to compare direct and indirect costs for frovatriptan compared with rizatriptan in the acute treatment of migraine, based on the patients’ preference for one or the other of the comparative drugs.