Everything You Need To Know About Triptans For Migraines

Triptans are a type of pain medication for migraine attacks.

While OTC pain relievers like acetaminophen, naproxen, and ibuprofen may be effective for moderate pain, triptans are typically prescribed for severe migraine headaches or when other treatment options don’t work.

Migraines are a common type of headache caused by a neurological condition.

They can include many symptoms beyond head pain, including:

• Pain on one side of the head
• Nausea and/or vomiting
• Light sensitivity
• Sound, vision, sensation, or motor disturbances
• Neck pain

This article explores how triptans work, when they may be prescribed, common side effects, and who should not take triptans.

What Are Triptans?

Triptans are a class of pain relieving medications used to treat migraine headaches and other conditions.

They do not prevent migraines but may help to address pain when OTC pain relievers are not strong enough.

Triptans belong to a class of drugs known as selective serotonin receptor agonists.

They work to relieve pain in migraine attacks by shrinking blood vessels that have swollen, causing moderate to severe head pain and other migraine-related symptoms.

Triptans are FDA-approved as a first-line treatment for acute migraine attacks with or without aura.

How do triptans work?

Triptans alleviate migraine head pain by binding to specific serotonin receptors.

During migraine attacks, blood vessels in the brain dilate, leading to moderate to severe head pain.

As a triptan binds to serotonin receptors, it causes the blood vessels to shrink.

Triptans also bind to another type of serotonin receptor, which prevents the activation of certain nerves and blocks certain pain signals that are sent to the brain.

Together these effects allow triptans to treat migraine head pain.

Triptan Uses

Triptans are prescribed for migraine pain relief.

They may also be used for cluster headaches or for menstrual migraines or PMS-related headaches that are severe.

They do not prevent migraines and do not reduce the frequency of migraine attacks.

Forms

Triptans are available as oral tablets, orally disintegrating tablets, nasal sprays, and injections.

The nasal sprays and orally disintegrating tablets are beneficial for people who struggle to swallow pills.

The orally disintegrating tablets are not a good option if vomiting is a typical migraine side effect.

In some cases, a healthcare provider may prescribe triptans to be taken along with NSAID over-the-counter pain relievers, since they target different pain pathways and help to manage inflammation.

Sumatriptan, a type of triptan, is available in a combination oral tablet that pairs a triptan with naproxen, an NSAID drug.

Side Effects

Triptans have some common side effects that may be referred to as “triptan sensations.”

Side effects are typically more pronounced at higher doses and when injections are used.

Triptan side effects can include:

• Nausea
• Dizziness
• Pins and needles sensations (paresthesia)
• Flushing
• Tingling
• Neck pain
• Chest tightness

Interactions

There are certain medications that may interact with triptans.

Make sure your healthcare provider and pharmacist know all of the prescriptions, OTC medications, street drugs, and supplements that you take to avoid potentially dangerous interactions and side effects.

Common interactions with triptans include:

• Other triptan medications
• MAOIs (monoamine oxidase inhibitors)
• Ergot derivative drugs (ergotamine)
• SSRIs (selective serotonin reuptake inhibitors)

There may be other potential interactions not listed here.

Always follow your doctor’s instructions and do not take new medications or supplements without consulting your physician.

Medication Names

There are seven types of triptans available in the United States.

• Sumatriptan (Imitrex, Treximet)
• Naratriptan (Amerge)
• Zolmitriptan (Zomig)
• Rizatriptan (Maxalt)
• Almotriptan (Axert)
• Frovatriptan (Frova)
• Eletriptan (Relpax)

Dosages

Dosages of triptans depend on the type of medication you are taking and the formulation.

Oral tablets, orally disintegrating tablets, nasal sprays, and injections all have distinctly different dosages.

Some common dosages for adults ages 18-64 who take triptans for migraine may include:

• Sumatriptan oral tablet: 25, 50, or 100 mg
• Sumatriptan nasal spray: 5-20 mg
• Sumatriptan injection: 1-6 mg
• Naratriptan oral tablets: 1-2.5 mg
• Zolmitriptan oral tablets: 1.25-2.5 mg
• Rizatriptan oral tablets: 5-10 mg

Triptans should only be taken at the onset of migraine pain as directed by your doctor and pharmacist.

Who Should Avoid Triptans?

There are many reasons why triptans may not be safe or effective for certain people.

Health reasons to avoid triptans include, but are not limited to:

• Myocardial infarction, coronary artery disease, or uncontrolled hypertension
• Cerebrovascular accidents
• Hemiplegic migraine
• Peripheral vascular disease
• Liver or kidney failure
• Being age 65 or older
• Pregnancy and breastfeeding (except, in some cases, sumatriptan)
• Sensitivity or allergy to any ingredients in triptan medications

Alternative Migraine Medications

There are many ways to treat migraine head pain.

Many OTC pain relievers are effective for migraines.

These include:

• Aspirin
• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin)
• Naproxen (Aleve)
• Excedrin, which combines acetaminophen, aspirin, and caffeine

If over-the-counter pain relief is not enough, there are other prescription options available besides triptans.

These include the following:

• Dihydroergotamine
• Anti-nausea drugs (chlorpromazine, metoclopramide, others)

While opioids may be effective for migraine pain, and are sometimes still used, the risk of dependence is strong so healthcare providers will usually use other options first.

There are also medications that may prevent migraine attacks versus treating the pain.

These may be used for people who experience frequent migraines.

Options include:

• Certain antidepressants (amitriptyline, fluoxetine, paroxetine, sertraline, others)
• Anticonvulsants (gabapentin, levetiracetam, pregabalin)
• Beta-blockers (atenolol, metoprolol, propranolol, others)
• Calcium channel blockers (diltiazem, nimodipine, verapamil)
• CGRP antagonists (erenumab, fremanezumab)
• Botox injections

Your healthcare provider will consider your symptoms, the frequency of your migraines, and the severity of your pain to determine the appropriate medication for you.

By including lifestyle adjustments and avoiding common migraine triggers, you may be able to reduce the number of migraines you have.