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What You Need to Know About Triptans

The "triptans" are a family of drugs that were developed to treat acute migraine headache. There are the oral triptans: Imitrex (sumatriptan), Amerge (naratriptan), Zomig (zolmitriptan), Maxalt (rizatriptan), Axert (almotriptan), Frova (frovatriptan), or Relpax (eletriptan), and two triptans marketed as nasal sprays: Imitrex nasal spray or Zomig nasal spray.

Although all of the oral and intranasal triptans initially were investigated for the treatment of migraine headache of moderate to severe intensity and were superior to placebo in those pivotal trials, they appear to be more consistently effective when used to treat migraine earlier in the attack, when the headache is still mild to moderate.

Frova and Amerge have a slower onset of action and longer biologic half-life in the body than the other triptans, and it is probably best to use them particularly early in an attack. The intranasal triptans, Imitrex nasal spray and Zomig nasal spray, tend to have a faster onset of action than the orally administered triptans, and some patients find that they are most effective than their oral counterparts in attempting to treat headaches that have progressed to a higher level of pain intensity.

Zomig and Maxalt are sold in "melt" formulations as well as in tablet form. While the "melt" formulation may be more convenient (no liquid is required to wash them down) and may be preferred by patients who have migraine-associated nausea, there is no evidence to suggest that they work faster than the tablet formulations.

Potential side effects of the triptans include nausea; jaw, neck or chest tightness, pressure or squeezing; rapid heart rate; fatigue; numbness-tingling (especially involving the face); or a burning sensation over the skin. While these and other side effects are not uncommon, the triptans are a very safe class of medications when used appropriately by the patients for whom they are indicated. Interestingly, side effects seem to be less likely to occur when the triptan is taken early in the migraine attack.

The triptans are not effective for all migraine patients and will not stop every headache even in those patients who do benefit from the drugs. Furthermore, if your response to the triptan you have been prescribed is less than desired, it may make sense to move on and try another.

Contraindications to the use of the triptans include coronary artery disease, a history of stroke, uncontrolled high blood pressure, and co-administration of certain other medications. Check with your physician regarding the last, and confirm that the medications you are taking are safe to use with the triptans.

Above content provided by the American Headache Society in partnership with Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted October 2009

Contact Information

Arnold Pain Management Center
Beth Israel Deaconess Medical Center
One Brookline Place, Suite 105
Brookline, MA 02445