A common abortive treatment for migraines, triptans are a family of drugs that act as a serotonin agonist. The specific receptors that these drugs target (5-HT1B, 5-HT1D and in some cases 5-HT1F) cause a combination of blood vessel constriction and suppression of inflammation. These primarily affect areas in the brain. The theory follows that by constricting the blood vessels one can reduce pain caused by pressure or tension in the neurons and/or smooth muscles of the blood vessels.
Triptans are targeted specifically to migraines and are considered a mid-tier treatment. They are usually introduced when more conventional over-the-counter drugs prove ineffective. Triptans are not intended for preventative use but instead should be taken at the onset of a migraine. Always consult your doctor before taking prescription drugs.
Common side effects
In general, triptans are considered to have relatively few side effects. Common side effects are:
- Soreness or achiness, especially in the shoulders and neck
- Sensitivity in the skin, sensation similar to a sunburn
- Tightness in the chest
- A mild sense of fatigue
- Upset or sour stomach
Some patients describe the feeling as cold or flu like. Most of these drugs can affect your focus and reactions, so avoid driving or operating machinery.
There are some serious adverse effects that you should keep an eye out for:
- Seizure or convulsions
- Severe chest pain
- Heart attack-like symptoms
- Cramping or severe numbness in extremities
- Stroke-like symptoms (weakness or numbness especially on one side of your body, speech difficulty)
- Vision problems
- Vomiting
Your doctor should be checking you for major risk factors before prescribing one of these drugs. Generally they are looking at blood pressure or heart irregularities. Because triptans mess with the serotonin pathways, there are concerns about serotonin syndrome. Most of the serious adverse effects to look out for in fact are that same as those seen in people suffering from serotonin syndrome. This is generally considered only a problem if you are taking other drugs that also influence serotonin, in particular MAOIs.
There have been some studies on extended use of triptans and barring complicating conditions they found few issues. The biggest concern if you are dealing with on the order of 10-15 migraine days per month are medication overuse headaches.
Imitrex (Sumatriptan)
Imitrex has been available for treatment of migraines since 1991 and has been on the market longer than any other triptan. It’s original patent has since run out and it can be found in generic form.
The most common form of this drug for self administration is as a tablet, but in recent years it has been made available as a nasal spray. Sumatriptan also can be found as an injectable. Relative to the tablet, nasal sprays and injectables begin acting much more quickly and with fewer side effects.
Treximet
Sumatriptan is generally shown to work better in concert with naproxen (Aleve). The Treximet branded drug is formulated to dissolve the sumatriptan and naproxen in a coordinated way, though a similar benefit can be achieved by combining a prescription sumatriptan with an over-the-counter naproxen. Naproxen is an NSAID and as such has its own complications to account for. Consult your doctor before mixing medications.
Relpax (Eletriptan)
Relpax came on the market around 2002 and is not yet available in a generic form. By 2018 generic options should be on their way. Relpax follows the same mechanisms as all triptans, but has some broader affinity to the 5-HT1 receptors. It affects 5-HT1F in addition the more common triptan targeted receptors, as well as several others to a lesser extent.
Relpax has been shown to be more effective in stopping migraines when compared to Sumatriptan with similar side effects at a lower dosage.
In a large meta-analysis of migraine treatments the authors found that rizatriptan and eletriptan were superior to the alternative triptan options. Their recommendation was that eletriptan was the most effective treatment for migraine relief, though it should be pointed out that every person tolerates these drugs differently even despite their similar behavior.
Maxalt (Rizatriptan)
Rizatriptan has been around for slightly longer than Relpax but is much newer than sumatriptan. It can be found in tablet form as both a branded and generic formulation. In a study comparing rizatriptan and sumatriptan rizatriptan was shown to be marginally more effective at treating a migraine than sumatriptan even at a lower dosage. In a study looking at patient preference comparing rizatriptan and eletriptan it was found that more patients preferred rizatriptan due to more rapid symptom relief.
Zomig (Zolmitriptan)
Zolmitriptan is most frequently prescribed as a nasal spray, though it is also available as a dissolvable tablet. Zomig was among the first triptan based nasal spray options and is preferred by some for it’s rapid uptake compared to the more common tablet form of other triptans. Lately this feature is less of a differentiator given that sumatriptan among others have now been made available in a nasal spray.
A 2000 study showed similar or better effectiveness at lower dosages of zolmitriptan compared to sumatriptan.
Axert (Almotriptan)
Almotriptan is less commonly prescribed and has similar effectiveness to sumatriptan.
Frova (Frovatriptan)
Frovatriptan has been shown to lower the likelihood of migraine recurrence compared to alternative triptan treatments.
Amerge (Naratriptan)
Not widely available due to limited manufacture.