Find out how nasal sprays treat migraine, the different types available and who is a good candidate for this migraine treatment.
When creating a migraine treatment plan with your doctor, you have many options for medications. A fast-acting, effective way to deliver relief, nasal sprays are one form of migraine treatment to consider. There are different types of nasal sprays that help with migraine care. Which one will work best for you may depend on your specific symptoms and the stage of your migraine. The other treatments you use matter as well.
Can nasal sprays help with migraine?
Nasal sprays are a great option for rapid delivery of medication to reduce pain and inflammation. Nasal sprays are especially helpful when you wake up with a migraine, when it is later on in a migraine attack or you are experiencing nausea or vomiting, which can make oral medications less effective. Because your nasal cavity has a lot of blood vessels, the medication enters your bloodstream more directly. So it doesn’t need to be broken down by your digestive system.
Nasal sprays enter the nostril with the head upright. This method ensures that the spray doesn’t go down the throat. Sniffing vigorously or holding the head tipped back does enter the throat. This not only tastes bad but would turn it into an oral medication. That impacts its effectiveness and delaying time to medication onset.
Which nasal spray is the best for migraine?
There are a number of options for nasal sprays. Nasal triptans (sumatriptan and zolmitriptan) and dihydroergotamine (DHE) contain migraine-specific treatment. Triptans and DHE are highly effective, but because they cause blood vessel narrowing, people with known or suspected vascular disease should not use them.
A third nasal option is a non-steroidal anti-inflammatory (NSAID) spray (nasal ketorolac), which targets migraine inflammation. Nasal ketorolac is the only nasal NSAID currently marketed and is FDA-approved for moderate to severe pain, though it is not FDA-approved as a migraine treatment. However, doctors sometimes prescribe it for acute migraine attacks.
People with known or suspected coronary artery disease should use NSAIDs cautiously. While NSAIDs do not cause blood vessel narrowing, they can increase risk of heart attack and stroke.
When should I use a nasal spray? Can it be used with other treatments?
You cannot mix different triptan types. Meanwhile, nasal DHE should not be taken within 24 hours of a triptan. In addition, you should not take nasal ketorolac on the same day as other NSAIDs, like ibuprofen, diclofenac or naproxen.
A combination of triptan or DHE plus an NSAID may improve the benefits of both drugs, reversing inflammation and blood vessel dilation, and potentially preventing pain recurrence.
Nasal DHE or NSAID migraine treatment can be effective later in a migraine. Triptans may be less effective when a person wakes up with a migraine that has progressed to the point of extreme sensitivity to light, sound, touch and smells.
As many as 40% of people do not respond to triptans. So nasal DHE or nasal ketorolac can be a better option for these patients. Both nasal DHE and nasal ketorolac are also effective as a “rescue” for migraine attacks that have not responded to several days of usual treatment, helping to avoid infusion therapy, injections or steroids or trips to the emergency department.
How long does a nasal spray take to work? How long do they last?
One of the main benefits of a migraine nasal spray is how quickly it takes effect. A single spray of a triptan nasal spray can provide relief in as little as 15 minutes, compared to about 30 minutes for an oral medication. While an injection can take effect within minutes, a nasal spray can be easier and less invasive to administer.
Nasal DHE is administered with one spray in each nostril. If your headache comes back after the first dose, or you only get partial relief from your headache, you can use a second dose (one spray in each nostril) one hour after the first dose. Do not use more than two doses within a 24-hour period, or three doses within a seven-day period.
Who is a good candidate for a migraine nasal spray?
A nasal formulation can be helpful if you have migraine with significant nausea, vomiting or gastroparesis (delayed stomach emptying); for fast-onset attacks or full-blown migraine attacks upon waking; or if you want to avoid injections or swallowing pills. For adolescents, zolmitriptan nasal spray is FDA-approved for ages 12 and up. Be sure to discuss your migraine symptoms with your doctor to find out if a nasal spray is right for you.
Many people with migraine have an acute oral treatment for slower onset, mild-moderate migraine, and a nasal spray for more severe migraine, or times they also experience nausea or vomiting.
Your doctor can help you create a treatment plan that includes a combination of oral and nasal medications. They can ensure the safe mixture of different options. Depending on your migraine symptoms and timing, you may get instructions to take one or the other medication to maximize relief and minimize side effects.
The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.
Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.