Triptans for Migraine Treatment

How Triptans Relieve Migraines and What to Watch Out For

In This Article

Triptans are prescription medications used to alleviate migraine episodes. They are specifically indicated for acute migraines and are not used for migraine prevention. Generally, if a person's migraines do not improve with tolerable doses of over-the-counter medications, then prescriptions, including triptans, are considered. Examples include Imitrex (sumatriptan) and Zomig (zolmitriptan).

Indication

If you have recurrent migraines, your doctor may consider prescribing a triptan for you to take when you have a migraine episode. There are several other prescription medications used for acute migraines, and your doctor will weigh the risks and benefits of each with you as you work on your migraine treatment plan together.

Triptans can be used for moderate to severe migraines, and they can also be used for mild migraines when non-steroidal anti-inflammatories (NSAIDs) and other over-the-counter options are not effective. They are often used for the treatment of menstrual migraines, migraines in young people, and migraines that are preceded by prodromal symptoms.

There are a number of symptoms that occur with migraines, including head pain, nausea, dizziness, fatigue, and tingling of the hands. Pain is the symptom that is most likely to improve with triptans.

How Triptans Work

Triptans bind to 5-hydroxytryptamine (5-HT, serotonin) receptors in the brain, increasing the effects of serotonin, a neurotransmitter that mediates pain and mood. Triptans are described as serotonin agonists because they amplify the effects of serotonin.

It has also been noted that triptans are vasoconstrictors, which narrow the lumen (opening) of blood vessels in the brain. They may block certain pain pathways in the brainstem as well.

It isn't clear which of these physiological effects is responsible for the action of triptans on migraines or whether it is a combination of several mechanisms.

Types and Formulations

There are currently seven types of triptans, all with similar chemical structures and mechanisms of action. Some people improve with one instead of another, and it is a good idea to stick with the same triptan so that you and your doctor can determine the right dose for you.

Of course, if your insurance coverage changes and your medication is no longer on the formulary or the cost increases, you can try another triptan. You will likely experience the same degree of migraine relief that you had with your previous triptan medication. However, you might notice that one triptan takes a longer or shorter time to start working, or that another has longer or shorter effects.

These triptans are all available in oral form; other forms are noted where applicable:

  • Imitrex, (sumatriptan): Indicated for adults over age 18; available in 25 mg, 50 mg, and 100 mg tablets. Imitrex also comes in a formulation that can be self-injected subcutaneously (SC) under the skin, a form that can be inhaled, and a suppository (inserted rectally). Alsuma, Sumavel, and Zembrace are injectable forms, and Onzetra is a nasal powder.
  • Relpax (eletriptan): Indicated for adults over age 18 and comes in 20 mg and 40 mg tablets
  • Zomig (zolmitriptan): Indicated for adults over age 18; comes in 2.5 mg and 5 mg tablets and dissolving tablets; is available in a formulation that can be inhaled that is approved for adults and for children 12 years of age or older
  • Amerge (naratriptan): Indicated for adults over age 18; comes in 1 mg and 2.5 mg tablets
  • Maxalt (rizatriptan): Indicated for adults over age 18 and for children ages 6 to 17 years old; comes in 5 mg and 10 mg tablets and dissolving tablets
  • Axert (almotriptan): Indicated for children ages 12 to 17 and adults over age 18; comes in 6.25 mg and 12.5 mg tablets
  • Frova (frovatriptan): Indicated for adults over age 18; comes in 2.5 mg tablets

Zecuity (sumatriptan), a patch that delivered the active medication transdermally (through the skin), was taken off the market in 2016 due to skin reactions at the site of the patch that included burn-like lesions and scars.

Side Effects

Triptans are effective migraine medications. That being said, they are prescription medications and need to be taken under the care of a physician. Some common side effects that can occur with triptans include:

  • Nausea
  • Jaw, neck, or chest tightness or pressure (a squeezing sensation)
  • Fast heart rate or increase in blood pressure
  • Fatigue
  • Numb/tingling sensation, especially of the face
  • Burning sensation of the skin

Contraindications

Some people should not take triptans because they could worsen an underlying health condition. It's important to review your medical history and all of your medications, including over-the-counter supplements and vitamins, with your personal physician before starting a prescription for triptans.

You should not take a triptan if you have a history of coronary artery disease, stroke, peripheral vascular disease, uncontrolled high blood pressure, or hemiplegic or basilar migraine. You should also not take a triptan if you are on certain anti-depressants that pose the potential for dangerous interactions (see below).

Pregnancy and Breastfeeding

If you are taking a triptan and plan on becoming pregnant or breastfeeding, speak with your doctor to determine the best treatment plan for your migraines. Triptans are category C drugs, which means that the risk versus benefit ratio must be weighed by the doctor for each individual patient.

The scientific data on using triptans while breastfeeding is limited and triptans should be used with caution.

Interactions

You should not use triptans on the same day as ergotamine or dihydroergotamine, which are also potent migraine medications that induce vasoconstriction.

Taking a triptan with a monoamine oxidase inhibitor, selective-serotonin reuptake inhibitor (SSRI), or selective norepinephrine reuptake inhibitor (SNRI)—all antidepressants that augment the effects of serotonin—can result in serotonin syndrome, a rare but potentially fatal condition.

A Word From Verywell

Triptans are among the most effective treatments for acute migraine attacks. While they aren't right for everyone, they can help reduce the severity and duration of a migraine. And some people can avert the painful phase of a migraine by using a triptan as soon as prodromal symptoms begin.

Be sure to follow prescription instructions and to talk to your doctor or pharmacist about dosing or usage questions. Familiarize yourself with the common side effects, and contact your doctor if you experience signs of serotonin syndrome or any unusual effects.

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