Oral and Intranasal Triptans for Migraine

Learn about how triptans work and who they can help, as well as dosing, side effects, and contraindications.

For many patients with migraine, medication can provide relief from acute symptoms or even prevent a full-blown migraine attack. A common medication family for acute treatment of migraine is a triptan. There are many options for triptans, depending on individual symptoms, how the triptan is used and whether there are any contraindications.

What are triptans? How do they work?

Triptans are a family of drugs used for the acute treatment of migraine. Triptans can be taken orally or intranasally. There are a number of oral triptans, including sumatriptan (Imitrex), naratriptan (Amerge), zolmitriptan (Zomig), rizatriptan (Maxalt), almotriptan (Axert), frovatriptan (Frova), or eletriptan (Relpax). Alternatively, your doctor may prescribe one of the triptans marketed as nasal sprays: sumatriptan nasal spray (Tosymra) or zolmitriptan nasal spray (Zomig).

Initially, these oral and intranasal triptans were studied in the treatment of migraine of moderate to severe intensity and were superior to placebo in those pivotal trials. But they appear to be more consistently effective when used to treat migraine earlier in the attack when symptoms are still mild to moderate.

Who is a good candidate for triptans?

Anyone with migraine—and without contraindications—is a good candidate for triptans. Sometimes they are less effective when patients have daily headache.

Triptans are not effective for all patients with migraine and will not stop every headache, even in those patients who do benefit from the drugs. If the triptan you have been prescribed is not providing relief, it may make sense to move on and try another. It can also be helpful to combine a triptan with another acute migraine treatment for better effect, as well as lifestyle changes for migraine management.

Contraindications to the use of triptans include heart disease (coronary artery disease); a history of stroke; uncontrolled high blood pressure; very long, severe, or hemiplegic auras; and co-administration of certain other medications. Check with your doctor to confirm that any other medications you are taking are safe to use with triptans.

You should also speak to your doctor about triptan use if you are planning pregnancy or breastfeeding, as not all triptans are recommended in these settings.

General dosing considerations for triptans

Discuss your migraine symptoms with your doctor to create an optimal treatment plan. Your doctor will provide instructions for when and how often to take your prescribed triptan.

Generally, patients with migraine will take 1 tablet (or administer 1 spray) for early/mild headache. This dose may be repeated after 2 hours, except for naratriptan and frovatriptan, which can be repeated after 4 hours. It is typically not advisable to use more than 2 doses within a 24-hour period or to use triptans for more than 10 days per month on a chronic basis.

Frovatriptan and naratriptan have a longer half-life than the other triptans, meaning that it may take longer to take effect. It is probably best to use them particularly early in an attack.

The intranasal triptans, sumatriptan nasal spray, and zolmitriptan nasal spray tend to have a faster onset of action than the orally administered triptans. Some patients find that they are more effective than their oral counterparts in treating headaches that have progressed to a higher level of pain intensity. Nasal spray triptans may also be more effective for patients with significant nausea or vomiting or who wake with an attack already established.

Zolmitriptan and rizatriptan are available in “melt” formulations as well as in tablet form. While the melts 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 tablets. Also, some patients are sensitive to melting ingredients like aspartame.

Side effects and contraindications of triptans

Potential side effects of triptans include nausea; jaw, neck, or chest tightness, pressure or squeezing; rapid heart rate; fatigue; numbness-tingling, especially involving the face; or a burning/flushing sensation over the skin.

While side effects are not uncommon, 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.

In the past, doctors were concerned about the risk of serotonin syndrome when triptans were taken together with medications that impact serotonin, like many antidepressants. However, more recent studies suggest that this risk is negligible.

Rizatriptan can interact with propranolol and the lower dose of rizatriptan may be used when someone is on propranolol. Triptans should not be used within 24 hours of an ergot-containing medication such as DHE. Most triptans should also be avoided in patients taking MAO-I inhibitors.

Triptans can be a very effective acute treatment for relieving migraine attacks. As with all treatments, we recommend talking to your doctor to find out if an oral or intranasal triptan is right for you.

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.