Triptans

Triptans are a group of painkillers used for migraine and cluster headaches. They work by releasing a chemical in your brain, called serotonin, which causes the blood vessels around the brain to contract (narrow). This reverses the dilating (widening) of blood vessels that's believed to be part of the headache process.

When are triptans used?

Triptans are used during migraine attacks, for immediate relief of symptoms that have already begun. They are usually used if paracetamol or NSAIDs such as ibuprofen or diclofenac, don't help to relieve your migraine symptoms. Some people find using triptans together with paracetamol or NSAIDs effective. Read more about medicines for migraine.

Sumatriptan injection is also used to treat cluster headaches.  

Timing

Triptans are most effective if taken at the first signs of a migraine attack while the pain is still mild, as this gives it time to absorb into your bloodstream and ease your symptoms. A triptan should be taken early during a migraine attack but not during the aura phase.

Examples of triptans available in New Zealand

Triptans are available as tablets or injection.

Triptan Also called
Rizatriptan tablets

  • Rizamelt®
Sumatriptan tablets
  • Imigran®
  • Arrow-Sumatriptan®, Apo-Sumatriptan®
  • Sumagran Active®, Mygran®
Sumatriptan injection
  • Imigran®
  • Clustran®
  • Arrow-Sumatriptan®
Note: Zolmitriptan nasal spray (Zomig®) is no longer available in New Zealand.

Which triptan – how do I choose?

Most triptans are similarly effective, so choice is usually based on personal preference. 

  • Tablets: if you prefer taking tablets, then sumatriptan or rizatriptan tablets may be useful. Rizatriptan tablets dissolve when placed on the tongue. They may be useful if you find drinking water during a migraine difficult or if you cannot swallow tablets. They are not useful if you are vomiting.
  • Injection: an injection may be better if you are vomiting, or if you develop a sudden migraine.

If one triptan does not relieve your migraine symptoms, you can try another one next time. If you do not respond to triptan tablets, you can give the injection a try.

How to take triptans safely

Repeat doses

Do not repeat the dose of a triptan if you are not responding to the first dose. The dose can be repeated after 2 to 4 hours if there was initial relief from the migraine and it has then reoccurred. Be careful not to exceed the maximum daily dose. The following is a guide to repeated doses:

  • Sumatriptan tablet
    • dose may be repeated after 2 hours if migraine recurs
    • maximum 300 mg in 24 hours
  • Sumatriptan injection
    • dose may be repeated once after one hour if migraine recurs
    • maximum 12 mg in 24 hours
  • Rizatriptan tablet 
    • dose may be repeated after 2 hours if migraine recurs
    • maximum 30 mg in 24 hours.

Do not use triptans for more than 10 days per month

Medication overuse (also called rebound) headache is a headache cause by overuse of painkillers to treat headache, including the use of triptans for migraine. The symptoms include a tension-type headache or migraine-like attack. Headaches often improve within 7 to 10 days after the triptan has been stopped. Symptoms may be worse before an improvement is seen.

To avoid this, do not use triptans for more than 10 days per month. 

Precautions – before taking triptans

If you answer 'yes' to any of the following questions, it’s important that you tell your doctor or pharmacist before starting on a triptan.

  • Do you have problems with your liver or kidneys?
  • Do you have problems with high blood pressure (hypertension)?
  • Have you had a heart attack or do you get angina (chest pain)?
  • Have you had a stroke or do you get transient ischemia attacks?
  • Are you pregnant?
  • Are you breastfeeding?
  • Are you taking medication for depression?

Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

What about side effects

Like all medicines, triptans can cause side effects, but not everyone gets them. Often side effects improve as your body gets used to the medicine. Common side effects of triptans include:

  • feeling sick (nausea), dizziness and dry mouth
  • strange sensations such as tingling, flushing, or feeling of tightness or pressure in areas such as your face, limbs, and sometimes chest
  • your skin becoming very sensitive to touch, loss of sensitivity to heat and cold
  • hunger 
  • pain and discomfort in the lining of your nose, with use of the nasal spray
  • soreness and tingling at the injection site, with use of the injection.

Learn more

The following links provide further information about triptans. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

Triptans Patient Info, UK, 2016

References

  1. Treatment of acute migraine New Zealand Formulary
  2. The role of triptans in the treatment of migraine in adults BPAC July 2014, NZ
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 06 Nov 2017