Using Zolmitriptan for Migraine Relief

A drug used off-label to prevent menstrual migraines

Zolmitriptan, available under the brand name Zomig, is a medication approved by the FDA to treat migraines with or without auras in adults. In addition, zolmitriptan nasal spray (Zomig ZMT) is FDA-approved to treat migraines with or without aura in both adults and children 12 years of age and older.

It's also used off-label to treat menstrual migraine, a type of migraine experienced by women just prior to and during the first couple days of menstruation.

Dosing

As with other triptans, in order to optimize the likelihood that Zomig will alleviate your migraine, it's important you take the drug at the onset of your migraine.

Tablet

With oral zolmitriptan, the tablets are available in two strengths: 1.25 milligrams (mg) or 2.5mg. A person can take either 1.25mg, 2.5mg, or 5mg (two 2.5mg tablets) as the first dose. If their migraine headache is not resolved or if the headache returns after improvement, a second dose of zolmitriptan may be repeated in two hours (after the first dose).

Keep in mind, the maximum daily dose of zolmitriptan is 10mg within a 24-hour period.

It's interesting to note that research has not found an added benefit from taking the 5mg dose compared to the 2.5mg dose, but adverse effects were more frequent with the 5mg dose. 

Oral Disintegrating Tablet

Besides tablets, there are oral disintegrating tablets available in 2.5mg and 5mg doses. These tablets dissolve on your tongue and cannot be broken or split.

Again, the maximum daily dose of zolmitriptan is 10mg within a 24-hour period.

Nasal Spray

With the zolmitriptan nasal spray, a single dose of 2.5mg given in one nostril OR a 5mg dose can be given as a 2.5mg dose in each nostril. If the migraine headache persists or returns within two hours of the dose, a second dose may be repeated once.

Similar to the tablets, the maximum daily dose should not exceed 10mg.

Special Cases

For those with moderate to severe liver impairment, the FDA recommends only taking 1.25mg tablets (by breaking the 2.5mg zolmitriptan tablet in half). In addition, the maximum daily dose should be 5mg of zolmitriptan, as opposed to 10mg. Keep in mind that the oral disintegrating tablets should not be used because they cannot be broken in half.

Zolmitriptan also interacts with the drug Tagamet (cimetidine). If a person is taking both medications, the maximum single dose of zolmitriptan should be limited to 2.5mg, and the maximum daily dose should not exceed 5mg.

Adverse Effects

As with any medication, there are potential adverse effects. It's important to review these with your doctor and contact him or her if they do occur. While not an exhaustive list, there are some more common adverse effects experienced by those taking zolmitriptan.

  • Neck, throat, or jaw tightness, pressure, or dizziness
  • Numbness and tingling
  • Weakness
  • Sleepiness
  • Warm/cold sensation
  • Nausea
  • Heaviness sensation
  • Dry mouth

Additionally, the zolmitriptan nose spray may cause an unpleasant taste in your mouth.

Contraindications & Cautions

Due to the fact that zolmitriptan (and/or other triptans) has been linked to several serious conditions, such as a heart attack within a few hours of taking the drug, potentially life-threatening heart arrhythmias, serotonin syndrome, and an increase in blood pressure, there are several contraindications to taking this drug.

Migraine Medications and Serotonin Syndrome

These contraindications include:

Experts suggest caution in taking a triptan if a patient has risk factors for coronary heart disease, like obesity, a history of smoking or diabetes, or a family history of heart disease. People with these risk factors should undergo a heart evaluation before starting a triptan, including zolmitriptan.

Lastly, the zolmitriptan oral disintegrating tablets (Zomig-ZMT) contain a substance called phenylalanine (a component of aspartame). Ingesting phenylalanine can be harmful to people with phenylketonuria. Take note, the regular zolmitriptan tablets (Zomig) do not contain phenylalanine.

Please note that these above contraindications are not meant to worry or scare you. For the vast majority of people, zolmitriptan is a safe and effective migraine drug—but in a small subset of people, choosing a different migraine therapy is important.

Menstrual Migraine Treatment

Menstrual migraines are common and tend to last longer, be more severe, and be more resistant to typical migraine pain-easing medications than non-menstrual migraines.

One comforting tidbit to know if you are taking a triptan like zolmitriptan (Zomig) to treat your menstrual migraines is that all triptans have been studied in the acute treatment of menstrual migraines, and all have been found to be better than a placebo (taking a sugar pill).

Moreover, triptans offer the added benefit of easing the associated symptoms of a migraine headache, particularly nausea and sensitivity to light (called photophobia).

What Causes Menstrual Migraines?

Menstrual Migraine Prevention

Research suggests that for menstrual migraines, zolmitriptan can be taken preventatively, starting two days prior to the expected beginning of your period and continued through to five days after the onset of menstruation (seven days total).

Keep in mind, if you are considering a triptan for menstrual migraine prevention, you should also talk with your doctor about frovatriptan (Frova) or naratriptan (Amerge), which have also been studied for this purpose.

For what it's worth, the American Headache Society and the American Academy of Neurology list frovatriptan as "effective for the short-term prevention of menstrually associated migraines," and list naratriptan and zolmitriptan as "probably effective for the short-term prevention of menstrually associated migraines."

This is largely because there are two studies supporting the use of frovatriptan for preventing menstrual migraines versus only one study for naratriptan and zolmitriptan. With that, it's likely that any of these three triptans is a sensible choice for menstrual migraine prevention.

A Word From Verywell

There are numerous options available for treating your migraines, and often times, it's a trial and error process as you sort through which drug is right for you.

Take note as well, even if zolmitriptan or another triptan doesn't work for you, it's okay to try a different triptan. This may seem counterproductive, but for some reason, different triptans work for different people.

How to Prevent Migraines Before They Happen
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