OBJECTIVES: To assess utilization characteristics of triptan medications (sumatriptan, naratriptan, zolmitriptan and rizatriptan) and evaluate the need for migraine quality improvement programs in a managed care population. METHODS: Utilizing a pharmacy claim database from a managed care healthplan (over 1.9 million members), patients who have at least one triptan claim during 7/1/98-5/31/01 were identified. Patients were included if continuously enrolled for 12 months following the first triptan prescription and did not have a triptan claim during the previous six months. Patients receiving two or more different triptans within a 3-day period were considered concurrent triptan users. In order to standardize the quantity of triptan medication consumed per patient across the different triptans, 'headache equivalents' (HE) were calculated for each medication by dividing the quantity consumed by the maximum quantity recommended for one headache. The number of patients exceeding the recommended maximum consumption of 3 HE per month (36 HE per year) was determined. RESULTS: A total of 5,294 new triptan users were identified. Of these, 39% received only one triptan prescription during the follow-up period, accounting for 11% of the total triptan drug costs. Fifteen percent of the patients required more than one unique triptan medication and 4% concurrently used two or more triptans during the study period. Eight percent exceeded the recommended maximum consumption of 36 HE per year and were responsible for 39% of the total triptan expenditures. CONCLUSIONS: A notable number of patients received only one triptan prescription. A small percentage of patients received quantities exceeding recommendations and accounted for a large portion of the triptan pharmacy costs. Migraine quality improvement programs in these subsets of patients may be valuable.