Triptans

If pain relievers — with or without medicines for nausea and vomiting — are not relieving your migraine symptoms, triptan medicines are usually the next step. Triptans work differently to pain relievers and you will need to get a prescription from your doctor to obtain a triptan.

There are a number of different triptans available in Australia:

  • sumatriptan (Imigran and other brands) tablets, nasal spray and injection
  • zolmitriptan (Zomig) tablets
  • naratriptan (Naramig) tablets
  • rizatriptan (Maxalt) wafers
  • eletriptan (Relpax) tablets

Note about medicine names

Most medicines have two names: the active ingredient and the brand name. The active ingredient is the chemical in the medicine that makes it work. The brand name is the name given to the medicine by its manufacturer. There may be several brands that contain the same active ingredient. This website uses active ingredient names, with brand names in brackets. We also discuss medicines in groups or ‘classes’, when their effects or actions are very similar.

To find out more about active ingredients and brand names see our Brand choices information.

How do triptans work?

It’s not completely clear how triptans relieve migraine symptoms. They have some effect on the sensitive blood vessels around the brain but also act to calm down the migraine process in the brain.

As well as helping with the pain, triptans can relieve other migraine symptoms, such as nausea, vomiting and sensitivity to light and noise.

In about 1 in 3 sufferers, the migraine may reoccur up to 24 hours after the first dose of a triptan; often a second dose of the same medicine can relieve this. However, a second dose should not be taken within 2 hours of the first. It’s also important not to exceed the manufacturer’s daily dosage recommendations.

How to take a triptan

Triptans seem to work best if they are taken when a migraine is beginning to develop, and may be less effective if taken earlier (e.g. during aura) or later when pain is more severe.

Overall, triptans are effective in about two-thirds of people who suffer from migraine.

If you don’t respond to a particular triptan, it’s often worth trying another. If the triptan you’ve been prescribed doesn’t relieve your symptoms on three consecutive occasions, talk to your doctor about trying another medicine from the triptan family. Sometimes changing the way you take a triptan (e.g. from tablet to nasal spray or injection) can also make a difference.

In cases of severe migraine, especially where vomiting makes it impossible to keep medicines down, sumatriptan can be given by injection. People can be taught to administer this injection themselves, but it is an expensive treatment option.

Try not to take more than 10 triptan tablets each month, as you increase your risk of developing medication overuse headache. If you are suffering migraine attacks frequently and regularly, talk to your doctor about preventive therapy for your migraines.

Who can’t take triptans?

Unfortunately triptans are not suitable for everybody. You should avoid them if you:

  • have high blood pressure that is poorly controlled
  • have or are at high risk of heart disease (e.g. heart attack or angina), stroke or transient ischaemic attacks (TIAs, or ‘mini-strokes’), or peripheral vascular disease (reduced circulation caused by a narrowed or blocked blood vessels). Talk to your doctor if you are unsure whether this describes you
  • are elderly
  • have severe kidney and/or liver problems
  • are a child under 12 years of age. Triptan nasal sprays (not tablets) may be suitable for use by teenagers aged 12–17 years.

If you are pregnant or breastfeeding consult your doctor before you take a triptan.

What are the side effects of triptans?

Not everyone will experience side effects, however some of the more common side effects of the triptans include:

  • feelings of tingling, heat, pain, heaviness or tightness in any part of the body, including the chest or throat
  • flushing, dizziness, weakness, drowsiness, tiredness
  • vomiting, dry mouth
  • a short-term increase in blood pressure.

Rashes can occasionally occur.

Overuse of triptans — defined as taking them on 10 or more days a month — can lead to medication overuse headache.

Who can I ask about side effects?

To report possible side effects call the NPS Adverse Medicine Events (AME) Line on 1300 134 237 from anywhere in Australia (Monday–Friday, 9am–5pm AEST). People with questions about their medicines or seeking general information about side effects can also call the NPS Medicines Line on 1300 633 424 (Monday-Friday, 9am-5pm).

Interactions

It is important to tell your health professional about all the medicines you are taking — including prescription, over-the-counter and complementary medicines (herbal, ‘natural’, vitamins and minerals) — as they may interact with triptans

Medicines that may interact with the triptans include:

  • Other migraine treatments, including ergotamine, dihydroegotamine, and other triptans. These medicines should not be taken at the same times as a triptan.
  • Antidepressants including monoamine oxidase inhibitors, moclobemide, selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs). This does not mean you will not be able to take antidepressants and triptans together, but it may influence the doctor’s choice of antidepressant and/or triptan for you.
  • St John’s Wort, a complementary medicine for depression.

See the consumer medicine information (CMI) leaflet for the triptan you are prescribed for more information, including:

  • how to take this medicine
  • what to do if you forget to take it
  • if you take too much (overdose)
  • things you must and must not do while taking this medicine
  • signs of severe reactions and what to do.
References
  • National Prescribing Service Limited . Headache and migraine. NPS News 38. Sydney: NPS, 2005. www.nps.org.au/health_professionals/publications/nps_news/archive/NPS_News_38
  • British Association for the Study of Headache. Guidelines for all health professionals in the diagnosis and management of migraine, tension-type-type headache, cluster headache and medication overuse headache. Hull: BASH, 2010. www.bash.org.uk (accessed 13 December 2011)
  • Neurology Writing Group. Therapeutic Guidelines: Neurology, Version 4 Updated November 2011 [eTG complete CD-ROM]. Melbourne: Therapeutic Guidelines Ltd, 2011.
  • Rossi S, ed. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2012.
  • Evers S, Afra J, Frese A, et al. EFNS guideline on the drug treatment of migraine - a revised report of an EFNS task force. European Journal of Neurology 2009;16:968-81. www.efns.org/fileadmin/user_upload/CME_articles/CME_article_2009_September.pdf