Triptans For Migraine: Uses, Side Effects, and Mechanism
Understanding some migraine medication history is helpful before you think of using triptans for migraine! Before ImitrexTM (sumatriptan) came on the market in the early ‘90s, migraine patients didn’t have many options for stopping an attack. Triptans, the class of medications that sumatriptan belongs to, were game-changing for migraine patients.
Now, triptans are often the first medication that you’ll receive when you seek medical help for migraine. Even as new medications, such as CGRP inhibitors, come on the market, triptans remain an effective acute treatment for migraine.
In this post, we’ll explore triptans’ mechanism of action and discuss triptans’ side effects and contraindications. We’ve also included some triptans examples and compared new drugs such as Ubrelvy versus triptans.
What are triptans?
Triptans are an acute treatment for migraine. You take triptans when you feel a migraine attack starting, or when an attack is already happening. Doctors usually prescribe triptans as the first medication for migraine patients to treat migraine symptoms.
Triptans come in many different forms, including tablets that you swallow, tablets that dissolve, and nasal sprays.
Here’s a list of triptans that your doctor might prescribe:
- Almotriptan: Also known as Axert. Comes in oral forms. Unfortunately, the brand name version is not sold in the US anymore.
- Eletriptan: Also known as Relpax
- Frovatriptan: Also known as Frova.
- Naratriptan: Also known as Amerge.
- Rizatriptan: Also known as Maxalt.
- Sumatriptan: Also known as Imitrex. Comes in a nasal spray, oral medication and subcutaneous (shallow injection under your skin’s surface) forms
- Zomatriptan: Also known as Zomig. It also comes in both oral and nasal forms.
In some countries, over-the-counter triptans are available (but you can’t get triptans OTC in the United States).
How do triptans work?
Let’s look at triptans’ mechanism of action. Triptans are designed to respond to the fact that cranial arteries dilate during a migraine attack, causing pain. By stimulating serotonin, which is a neurotransmitter, or a chemical that carries messages within your body, this constricts blood vessels in order to stop the migraine attack.
What are some side effects of triptans?
Common side effects of Triptans include:
- chest tightness
- muscle pain
- paresthesia (a prickling sensation, or “pins and needles”)
Overuse of triptans can also lead to medication overuse headache, which means that medication can actually cause more frequent and severe headaches. For triptans, overuse is defined as taking triptans 10 or more days per month.
If you’re worried about medication overuse, you can talk to your doctor about preventive treatments, which can include medications such as Aimovig injections or non-pharmaceutical treatments such as acupuncture.
Are there contraindications for triptans?
Some people may not be able to safely use triptans. We’ve listed some triptans contraindications below, but you should talk to your doctor before trying triptans. Each triptan is different and has unique side effects and contraindications.
As mentioned, triptans work by constricting cerebral blood vessels — but they can also constrict coronary and limb arteries. This means they’re contraindicated for patients with a history of vascular disease, such as heart attacks, hypertension, and coronary artery disease. Triptans are also contraindicated for people over 65 and people with severe liver or kidney failure.
Many patients wonder if it’s possible to use triptans in pregnancy. Currently, sumatriptan is the only triptan that is considered safe for use during pregnancy and breastfeeding. (That said, pregnant people should still consult with a doctor before taking triptans in pregnancy.)
Ubrelvy versus triptans for migraine
There have been exciting developments in acute migraine treatments in recent years. You might have seen ads for CGRP inhibitors, such as Ubrelvy and Nurtec, featuring celebrity spokespeople that also suffer from migraine, like Khloe Kardashian and Serena Williams
An interesting meta-analysis — a study that compares the results of other studies and clinical trials — set out to understand if CGRP inhibitors are better than triptans. Here’s what researchers learned about drugs like Ubrelvy versus triptans:
- Triptans were more likely to lead to pain freedom or pain relief than CGRP inhibitors.
- CGRP inhibitors were less likely to cause adverse events (side effects) than triptans.
- All treatments in the analysis were more likely to lead to pain freedom or pain relief than placebos.
Whether your doctor prescribes an older triptan or a newer CGRP inhibitor, you can trust that it may offer you relief.
How to get started with triptans for migraine
Triptans may no longer be the “new kid on the block,” but they are still widely prescribed and effective for many migraine patients . You can work with your doctor to explore if any of the triptans medications on the market work for you. If you decide to try triptans, don’t forget to use the Migraine Buddy app to track how you respond!
(The above article was written by Dana Cass, one of our amazing volunteers. If you’ll like to contribute to the migraine community, join us as a volunteer now!)