Almotriptan is a serotonin (5-hydroxytryptamine, 5HT)(1B/1D)-receptor agonist approved for the acute treatment of migraine. In 3500 acute migraine patients enrolled in short-term trials and 1500 patients in long-term open-label trials, almotriptan 12.5 mg was effective and well-tolerated. Almotriptan maintains a consistency of response across three attacks and patients continue to respond to almotriptan for up to 1 year. Results from two comparative studies and a meta-analysis of 53 randomised, placebo-controlled studies of oral triptans in > 24,000 patients, confirm that almotriptan 12.5 mg demonstrates comparable efficacy with sumatriptan 50 and 100 mg. The incidence of treatment-related adverse events with almotriptan is comparable to that of placebo and significantly lower than that with sumatriptan. Drug-drug interaction studies indicate that almotriptan may be coadministered with other commonly prescribed drugs without dose modification. Almotriptan can be recommended as first-line treatment for acute migraine.