Both ergotamine and tritpans are currently used in the treatment of acute migraine. Ergotamine is a traditional therapy with lower drug acquisition cost and less headache recurrence. It has been showed that tritpans are more efficacious than ergotamine. But their high acquisition costs and the short duration of action remain as their major disadvantages. OBJECTIVE: The purpose of this study is to provide a comparison of cost-effectiveness of rizatriptan and sumatritpan with Cafergot in the treatment of acute migraine attack. METHODS: Three separate models were developed based on a decision tree (Model 1: rizatriptan vs. Cafergot; Model 2: sumatritpan vs. Cafergot; Model 3: rizatritpan vs. sumatritpan). Time horizon was one year. Cost-effectiveness analysis was conducted from the societal perspective using data from the literature. All costs were converted to year 2003 dollars. The CE ratio was expressed in incremental cost/incremental QALYs. RESULTS: Base case evaluation showed that both rizatriptan and sumatriptan dominated Cafergot (provide the cost differences and QALY differences for the different Meds). Sensitivity analysis showed that the CE ratios were sensitive to moderate changes in effectiveness of triptans. The study further showed that rizatritpan is more cost-effective than sumatriptan, as evidenced by the negative CE ratio. Cost-effective ratios are not sensitive to changes of key variables, which include efficacy, utility, drug costs, hospitalization cost and patient preference over alternative therapies. CONCLUSION: Rizatriptan and sumatritpan are both more cost-effective than Cafergot in the treatment of acute migraine attack. Rizatritpan also dominated sumatritpan. Additional quality of life studies are needed to confirm the benefit from using triptans in management of migraine.