Triptans (serotonin receptor agonists) for migraine headaches
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How It Works
Triptans narrow (constrict) blood vessels in the brain and relieve swelling. Triptans have other properties that may help treat migraine symptoms. It is not clear how they work to stop a migraine. All of these drugs are available as tablets. Some tablets are designed to dissolve in your mouth. Sumatriptan is also available as an injection. Both sumatriptan and zolmitriptan are available as a nasal spray.
Why It Is Used
These drugs are used to effectively and quickly relieve headache pain, sensitivity to light and noise, and nausea and vomiting associated with migraines. They are especially helpful if you have moderate to severe headaches that interfere with your ability to perform daily tasks.
How Well It Works
These drugs are effective in reducing migraine symptoms and are well tolerated. But it is hard to know which triptan is the most effective.1 A triptan that works well for someone else may not work well for you. You may have to try more than one triptan to find the one that works best for you.
Triptans work best when they are taken as soon as the headache starts. But they can still reduce headache pain and other symptoms when taken after the attack has begun. You may need to take more than one dose of a triptan if your headache returns. But take the triptan exactly as it has been prescribed by your doctor, because potentially serious side effects can occur.
Some triptan drugs may also help to prevent migraines in women who get them only around the time of their menstrual period. A study suggested that these women may be able to prevent the headache by taking frovatriptan (Frova) for 6 days, starting treatment 2 days before their period begins.2 Frovatriptan is a triptan drug that is commonly used to relieve migraine pain after the headache has started.
Generally, these drugs are well tolerated and safe. But you may experience possible side effects that can include:
- A feeling of warmth or coldness.
- Burning at the injection site (with the injected form of sumatriptan).
- Bitter taste at the back of the throat (with sumatriptan and zolmitriptan nasal sprays).
Less common side effects can occur and may include an allergic reaction (a red, itching rash will appear, or you may have trouble breathing). Some people may experience temporary chest pressure or tightness, although this is usually not dangerous.
Because many people who have migraines also have depression, taking prescription medicines for both problems is common. In very rare cases, when a triptan such as sumatriptan (Imitrex) for migraines is taken with an SSRI (selective serotonin reuptake inhibitor) or SNRI (selective serotonin/norepinephrine reuptake inhibitor) such as fluoxetine (Prozac) or duloxetine (Cymbalta) for depression, these medicines can cause a very rare but serious condition called serotonin syndrome. But most people take these two types of medicines together and have no problems. If you are worried about serotonin syndrome, talk to your doctor.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
If your headaches return after you have taken a dose of a triptan, ask your doctor whether you can take an additional dose of the specific triptan you have been prescribed to reduce your migraine symptoms. If you do not find relief with one type of triptan, a different triptan may be more effective in reducing your migraine symptoms.
You may find that combining a triptan with a nonprescription medicine (such as acetaminophen or naproxen) helps to stop your headaches better. Talk to your doctor about this option if triptans alone aren't helping enough.
Triptans should not be taken with other drugs such as monoamine oxidase inhibitors (MAOIs) or other migraine drugs such as ergotamines. If you have risk factors for heart disease (such as high blood pressure, high cholesterol, diabetes, or being a smoker), triptans may not be right for you.
Overuse of migraine drugs can cause rebound headaches. Rebound headaches are different from migraine headaches. They are usually triggered after pain medicine has worn off, prompting you to take another dose. Eventually you get a headache whenever you stop taking the drug. Be sure to take your migraine medicine only as prescribed by your doctor.
- Morillo LE (2004). Migraine headache in adults, search date August 2003. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
- Silberstein SD, et al. (2004). A randomized trial of frovatriptan for the intermittent prevention of menstrual migraine. Neurology, 63(2): 261–269.
Last Updated: June 30, 2009