Using Sumatriptan for Migraine Relief

A drug with the advantage of offering many routes of delivery

Sumatriptan is a medication approved by the FDA to treat migraines with or without aura in adults. It's believed to work by narrowing blood vessels and blocking pain pathways in the brain.

The brands of sumatriptan in the United States include:

  • Alsuma (injection)
  • Imitrex (pill, nasal spray)
  • Imitrex STAT dose System (injection with a pen)
  • Onzetra Xsail (nasal powder)
  • Sumavel DosePro (a needle-free injection)
  • Zembrace SymTouch (injection)

As you can see, sumatriptan is available in many formulations, including a pill, a nasal powder, a nasal spray, and a subcutaneous (beneath the skin) injection.

Route of Delivery

The variable routes of sumatriptan delivery offer unique advantages for people who suffer from migraines. For instance, migraineurs who experience severe nausea and vomiting with their migraines are likely not too keen to take a pill—but an injection or nasal spray offers an alternative route.

Furthermore, the sumatriptan subcutaneous injection has a faster onset of action than a pill, providing more rapid relief for severe, debilitating migraines.

Dosing

Before taking a triptan, be sure to review the dosage with your doctor, especially since there are different starting points, as well as a maximum dosage allowed.

It's key to remember to take sumatriptan at the onset of your migraine, as waiting may significantly decrease the drug's effectiveness.

Pill

With oral sumatriptan, a person can take either a single dose of 25 milligrams, 50 milligrams, or 100 millgrams with fluids. If a person does not achieve satisfactory migraine relief by two hours after the first dose, a second dose may be taken.

Interestingly, research suggests that initial doses of 50 milligrams and 100 milligrams are not more effective than 25 milligrams, and that 100-milligram doses are not more effective than 50 milligrams (and may cause more side effects).

The total daily dose should not exceed 200 milligrams.

Powder

With the sumatriptan nose powder, a single dose of 22 milligrams (an 11-milligram nose piece in each nostril) is taken. Similar to the oral sumatriptan, if the migraine headache does not resolve within two hours (or it comes back), the dose may be repeated once.

The maximum daily dose should not exceed 44 milligrams (four nose pieces).

Spray

With the sumatriptan nasal spray, a single dose of 5 milligrams, 10 milligrams, or 20 milligrams is given in one nostril, OR a 10-milligram dose can be given as a 5-milligram dose in each nostril. If the migraine headache persists or returns within two hours of the dose, a second dose may be repeated once.

Research suggests that more patients obtain headache relief with an initial dose of 20 milligrams versus 5 or 10 milligrams.

The maximum daily dose is 40 milligrams.

Injection

With the sumatriptan injection (Alsuma or Sumavel), the initial dose is generally 6 milligrams, but if side effects are an issue, a person may opt to use a lower dose. If there is not relief within one hour after the initial dose, a second dose may be repeated.

The maximum daily dose is two 6-milligram injections.

With the sumatriptan injection (Zembrace), the initial dose is 3 milligrams. This dose can be repeated up to three times, with each injection separated by one hour.

The maximum daily dose is 12 milligrams.

Adverse Effects

Here are some of the more common potential adverse effects associated with sumatriptan:

  • Pins and needles sensation
  • Warm/cold sensation
  • Chest pain, tightness. pressure, and/or heaviness
  • Neck, throat, or jaw pain, tightness, and/or pressure
  • Vertigo
  • Malaise/fatigue

In addition, the sumatriptan nose spray or nose powder may cause a bad taste in your mouth, as well as nose and throat irritation. The nose spray may also cause a burning sensation when applied, and the nose powder may cause a runny or stuffy nose.

With the sumatriptan injection, some people develop irritation at the skin site where the shot is given.

Warnings & Contraindications

When taking sumatriptan, keep in mind that there are several warnings you should discuss with your doctor. Most notably, sumatriptan (and other triptans) have been associated with cardiovascular and vasospastic (when blood vessels spasm) events.

This is why triptans are contraindicated in people with a history of a heart attack, stroke, transient ischemic attack, coronary heart disease, peripheral vascular disease, ischemic bowel disease, or any type of angina (stable or Prinzmental's).

Likewise, experts suggest caution in taking a triptan if a patient has risk factors for coronary heart disease, such as obesity, a history of smoking or diabetes, or a family history of heart disease.

Other contraindications include:

Besides the above concerns, there is some worry for the development of serotonin syndrome in people who take a triptan along with a selective serotonin reuptake inhibitor (SSRI) or selective serotonin-norepinephrine reuptake inhibitor (SNRI). However, research suggests this risk is low.

With that, while it's prudent for you and your doctor to watch out for the symptoms of serotonin syndrome (if you are taking such a combination), it's probably not necessary to avoid taking a triptan solely for this concern.

Migraine Medications and Serotonin Syndrome

Lastly, it's important to note that sumatriptan is a pregnancy category C drug, so should only be taken if the potential benefit outweighs the potential risk to the baby (and only under the guidance of your doctor).

Keep in mind that sumatriptan is generally a safe and well-tolerated drug, so these contraindications and warnings are not to meant to scare you—only to educate you, so you and your doctor can make the best decision for your migraine care.

Other Triptans

It's important to note that there are other triptan drugs available for migraine treatment, such as Amerge (naratriptan), Frova (frovatriptan), Maxalt (rizatriptan), Relpax (eletriptan), and Zomig (zomatriptan).

The decision about which triptan to choose is really a personal preference, and something each person should discuss with his or her own physician.

Considering the limited number of trials comparing the triptans, the choice has more to do with factors like the route of administration (for example, oral versus injection), cost, convenience, and unique pharmacology of the drug (for example, a shorter- versus longer-acting drug).

In addition, there is a combined drug, sumatriptan and the nonsteroidal anti-inflammatory (NSAID) naproxen, called Treximet. According to a large review study, Treximet was found to be more effective in treating a migraine headache than either sumatriptan or naproxen alone.

How Triptans Relieve Migraines and What To Watch Out For

A Word From Verywell

The take-home message here is that sumatriptan is a sensible and generally safe and effective drug option for treating moderate to severe migraines. In the end, choosing which triptan is right for you is a personal decision and one that may entail a trial and error process.

Finally, besides triptans, there are several other migraine therapies out there, including a new drug that blocks calcitonin gene-related peptide (CGRP) called Aimovig (erenumab).

How to Prevent Migraines Before They Happen
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Article Sources
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