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To review the epidemiology and clinical features of migraine and to discuss the use of the 5-HT1B/1D agonists (triptans) in the treatment of moderate to severe migraine.A Medline search was conducted for relevant recent articles on migraine and the efficacy and safety of the triptans.With the advent of a standardized classification system for headache to simplify migraine diagnosis, new approaches to treatment, and effective new therapies, such as the triptans, many patients have obtained significant relief from the pain and disability associated with migraine.The key to successful migraine management is to provide the most effective treatment at the earliest possible time. Under the step-care approach to migraine management, the mildest and most conservative treatment was recommended as a first step, without regard for the degree of the patient's pain or disability. This approach has been replaced by stratified care, in which migraine management is based on the severity of the patient's pain and disability. Under the stratified approach, patients with moderate or severe migraine would be prescribed effective migraine-specific drugs, such as the triptans, as first-line therapy.