Written or medically reviewed by a board-certified physician. See About.com's Medical Review Policy.

Updated March 16, 2015.

You may take a triptan—even carry one around in your briefcase or purse—to alleviate a migraine attack as soon as it presents itself. Or you may have heard of triptans through the internet or your doctor but never tried one.

Here is a question and answer style format on the basics of triptans.

When are Triptans Used?

Triptans are used to treat moderate to severe migraines, as well as mild migraines that are not responsive to over-the-counter medications (i.e.


NSAIDs).

How Do Triptans Work?

Triptans are serotonin receptor 5-HT1B and 5-HT1D agonists. This means the triptans bind to and activate serotonin receptors in the same way that serotonin (a neurotransmitter or chemical in our brain) would.

The triptans alleviate migraines by causing vasoconstriction (narrowing of blood vessels) around the brain and blocking pain pathways in the brainstem. They also prevent nerve transmission in the trigeminal nucleus caudalis, likely through reducing the levels of CGRP—a protein elevated during migraine attacks.

What are the Different Types of Triptans?:

Triptans can be taken orally, intranasally, or subcutaneously (injected). They also have variable onsets of action and half-lives—meaning some last longer than others. For example, the half-life for sumatriptan is 2 hours and the half-live for frovatriptan is 36 to 30 hours.

Here are the different types of triptans and their route of administration.

• Almotriptan (Axert): oral
• Eletriptan (Relpax): oral
• Frovatriptan (Frova): oral

• Naratriptan (Amerge): oral
• Rizatriptan (Maxalt, Maxalt MLT): oral, oral disintegrating (dissolves in mouth)
• Sumatriptan (Imitrex, Zecuity): oral, intranasal, subcutaneous, or transdermal
• Zolmitriptan (Zomig, Zomig-ZMT): oral, oral disintegrating, intranasal
• Sumatriptan/naproxen (Trexima): oral

What are the Side Effects of Triptans?:

Triptans are considered to be safe medications when used in the appropriate setting for the appropriate reason. Triptans are prescribed medications and should only be taken under the care of a physician. Potential side effects include:

• Nausea
• Jaw, neck, or chest tightness or pressure or squeezing sensation
• Fast heart rate
• Fatigue
• Numb/tingling sensation (especially of the face)
• Burning sensation of the skin

Who Should Not Take Triptans?:

You should not take a triptan if you have a history of coronary artery disease, stroke, peripheral vascular disease, uncontrolled high blood pressure, or hemiplegic or basilar migraine. Triptans are also contraindicated in people who are concurrently taking monamine oxidase inhibitors.

Combining triptans with selective-serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors (SNRIs) can result in serotonin syndrome. This is a potentially fatal condition that may cause a variety of symptoms (including but not limited to) :

• confusion
• agitation
• diarrhea
• sweating
• loss of balance
• shivering
• tremors
• fever

In terms of pregnancy, triptan is a category C drug, which means that the risk vs benefit ratio must be weighed by the doctor for each individual patient.

Is There a New Triptan Formulation?

Yes! The newest triptan approved by the FDA is Zecuity, a sumatriptan iontophoretic transdermal system. Zecuity is a battery-powered skin patch that administers sumatriptan through your skin. In a study in Headache of 469 patients, Zecuity was found to be effective and well-tolerated. It may be a particularly good triptan for people who suffer from migraine-related nausea and vomiting.

Take Home Message

Triptans are great options for treating migraines when given under the guidance of a physician. The unique route of administration (transdermal and intranasal) is especially helpful in treating those who suffer from migraine-related nausea and vomiting. Be an advocate for your own health and speak with your doctor about whether this therapy could be right for you.

<sub>Sources

Ables, A and Nagubilli R.Prevention, Diagnosis, and Management of Serotonin Syndrome. Am Fam Physician. 2010 May 1;81(9):1139-1142.

Bartsch T, Knight YE, Goadsby PJ. Activation of 5-HT(1B/1D) receptor in the periaqueductal gray inhibits nociception. Ann Neurol. 2004 Sep;56(3):371-81.

Ferrari MD, Saxena PR. On serotonin and migraine: Aclinical and pharmacological review. Cephalalgia. 1993;13:151–165.

Gilmore B, Michael M. Treatment of Acute Migraine Headache. Am Fam Physician. 2011 Feb 1;83(3):271-280.

Goldstein J, Smith TR, Pugach N, Griesser J, Sebree T, Pierce M. A sumatriptan iontophoretic transdermal system for the acute treatment of migraine. Headache. 2012 Oct;52(9):1402-10.

http://www.americanheadachesociety.org/assets/1/7/John_Rothrock_and_Deborah_Friedman_-_Triptans.pdf. Accessed February 21st 2015.

Tfelt-Hansen P, De Vries P, Saxena PR. Triptans in migraine: a comparative review of pharmacology, pharmacokinetics and efficacy. Drugs. 2000 Dec;60(6):1259-87.</sub>
 

 

DISCLAIMER: The information in this site is for informational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for advice, diagnosis, and treatment of any concerning symptoms or medical condition.