Researching migraine treatments can feel overwhelming. And the advice you hear can range from “sleep it off” to “drink coffee” to “try triptans.” So it’s not surprising that you might start to feel a little lost as you try to figure out what’s right for your migraine.
Or what’ll actually work when you’re in pain.
Or even how to pronounce some of the words you come across.
Don't worry, you're not alone—not when it comes to suffering from migraine (one in seven people worldwide experience migraine attacks) and not when it comes to finding a treatment plan that'll give you more control over your condition.
In fact, Cove's entire mission is to make it easier for migraine sufferers to get ongoing support and access to the care they need. And that's why we're breaking down the most common migraine treatments and explaining them to you in a language that actually makes sense.
Let's begin with one of the more effective and well-known migraine treatments: triptans.
What are triptans?
Triptans are an FDA-approved prescription medication that help relieve migraine symptoms. They most commonly come in three forms: oral pills, nasal sprays, and shots. However, other forms, such as a suppository and a skin patch, do exist.
There are currently seven different triptan drugs prescribed in the United States:
- eletriptan (generic Relpax®)
- naratriptan (generic Amerge®)
- sumatriptan (generic Imitrex®)
- rizatriptan (generic Maxalt®)
- zolmitriptan (generic Zomig®)
- almotriptan (generic Axert®)
- frovatriptan (generic Frova®)
Here at Cove, we currently prescribe oral triptans only (specifically eletriptan, naratriptan, sumatriptan, zolmitriptan, rizatriptan, and rizatriptan ODT, which dissolves in your mouth).
How do triptans work to provide migraine pain relief?
Before we jump into how triptans work, let's quickly recap what doctors believe causes migraine attacks: For unclear reasons, in patients with migraine, nerves fire throughout the brain in a wave called a cortical spreading depression. This leads to changes in your brain's blood vessels and inflammation, which ultimately causes headache pain.
Triptans work to alleviate migraine through a variety of ways. These include constricting blood vessels in the brain, slowing down inflammation, and blocking pain pathways.
Think of your migraine as a toddler having a temper tantrum and the triptan as a parent soothing them (and reminding them how a brain is supposed to behave).
When do you take triptans?
Triptans are prescribed for acute migraine relief (a.k.a. pain relief), which simply means you take them when you start to feel a migraine attack coming on. The sooner you take them, the more likely they are to be effective.
How do you take triptans?
When it comes to oral triptans, you'll want to grab a glass of water and swallow the tablet whole. They can be taken with or without food, so don't worry about needing a snack.
In terms of timing, take them as soon as you feel a migraine headache coming on—the sooner you take them, the more effective they’ll be.
Most importantly, be sure to take them as prescribed.
How often do you take triptans?
You should start by taking one dose. If you’re still in pain after two hours, you can take a second dose.
Do triptans become less effective the more you take them?
You might’ve heard that taking too many triptans will eventually make them ineffective. While there’s no scientific evidence confirming that rumor, there is research that indicates that taking more than two to three triptans tablets a week could result in MOH (medication overuse headaches). While the chances are low that this will happen—1-2% of patients—it’s best to keep your intake below three tablets per week.
In fact, doctors typically recommend that patients who experience more than two migraine attacks per week start taking preventive medication.
How long does it take a triptan to start working?
Many people start to feel results within two hours of taking their triptans, with some triptans, such as sumatriptan, working within 20-60 minutes.
We know that those two hours can feel especially long during a migraine episode, which is why we also recommend practicing self-care—whether that’s leaving work early and lying down in a dark room, drinking caffeine, or doing whatever it is that makes you feel better. (If you’re not sure what would make you feel better, or you need some fresh ideas, here's a list of home remedies many migraine sufferers swear by.)
What do you do if you take a triptan and it doesn’t work?
If you wait two hours and your triptan’s still not working, you might have to use another acute treatment (like an NSAID) for that attack. You could also try heading to a dark, quiet room and using home remedies to help relieve the pain.
But don’t give up on that triptan altogether! Like many migraine medications, it can take a few tries to see if a triptan is going to work for you.
Tried the same triptan two or three times with no results? Speak to your doctor about trying a different triptan (there are seven options!). Yes, it might be tempting to conclude that triptans don’t work, but it’s possible that you just haven’t found the right one for you.
What other migraine treatments can be taken alongside triptans?
Studies have shown that taking a triptan and an NSAID (non-steroidal anti-inflammatory drug) during a migraine attack can be a very effective combination for managing pain.
In addition, you can also take an anti-nausea medication, such as metoclopramide, to help with any nausea (from the triptan or from your migraine itself).
Lastly, if you experience several migraine attacks a month, you might want to consider pairing triptans with a preventative treatment. Still, it’s best to take as few medications as possible in an effort to reduce side effects and cost. And it’s for this very reason that we recommend starting with one acute migraine treatment.
Which brings us to...
Who should take triptans?
Cove often recommends people who’ve only ever tried over-the-counter migraine remedies begin their treatment journey with triptan therapy (accompanied by an anti-nausea medication, if needed). We use the word journey on purpose: Everyone’s migraine is different, which means finding the best treatment plan for you might take time.
First triptan didn’t work? Don’t lose hope. We suggest trying at least two different triptans before ruling them out altogether. After all, despite all being in the same family, they’re each a little bit different.
Who shouldn't take triptans?
While triptans are generally considered safe and effective, there are people who should consider other migraine treatments. Namely:
- People who've tried two or more triptans in the past without results. In that case, we recommend discussing both an alternate acute treatment, as well as a preventive treatment, with your doctor.
- People who have or are at risk of having a stroke, heart disease, uncontrolled hypertension, or Prinzmetal’s angina.
- People who are taking monoamine oxidase inhibitors, more commonly known as MAOIs. (This is only in certain situations, so make sure to let your physician know if you're currently taking MAOIs.)
- People who are pregnant, planning to become pregnant, or breastfeeding.
While studies from The National Institute of Health have shown sumatriptans are safe for pregnant women and those who are breastfeeding, there's not enough research on the effects of other triptans.
All this said, every person is different and we recommend speaking with your doctor about your specific needs as well as any questions. (We know, we know, you want all the answers now, but we're committed to providing you with the best migraine care, and in this case, that means not making any claims we can't stand by.)
Are there any side effects?
While triptans are generally considered safe, like many medications, there are potential side effects. These could include:
- dizziness
- hot or cold flashes
- pressure in the chest
- tingling
- tiredness
While it’s exceedingly rare, there’s also risk of a stroke or cardiac symptoms. You should immediately contact your doctor if you experience signs of serious allergic reaction, dizziness, or difficulty breathing while taking these medications.
What triptans does Cove offer?
Cove currently offers five generic oral triptans for migraine headaches: eletriptan, naratriptan, sumatriptan, zolmitriptan, and rizatriptan, which is available as a standard tablet or an orally-dissolving tablet (ODT). We chose these triptans because they’re FDA-approved, fast-acting, and less likely to lead to side effects. Cove doctors usually prescribe sumatriptan first because it’s one of the most well-established and commonly used acute migraine therapies. If it doesn’t work, however, your doctor may choose another triptan that’s faster acting and potentially more effective—though this recommendation will, of course, depend on your personal medical history.
We know this is a lot of information on just one possible migraine treatment option. That’s why we work with licensed physicians to help each and every person find a treatment plan that works for them. If you’d like to speak to a Cove physician about your headaches, you can start here.
If you'd like to keep exploring your options, we recommend reading about other proven migraine treatments: NSAIDs for pain relief and beta blockers, anti-convulsants, anti-CGRPs, and antidepressants for preventative care.
The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
Eletriptan, naratriptan, and zolmitriptan are oral medications indicated for the acute treatment of migraine with or without aura in adults and is not used to prevent migraines. Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using this drug while you are pregnant. Tell your doctor if you are breast-feeding. Call your doctor right away if you have allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue, chest pain or chest tightness, signs and symptoms of a dangerous change in heartbeat or heart rhythm like chest pain; dizziness; fast, irregular heartbeat; palpitations; feeling faint or lightheaded; falls; breathing problems. Call your doctor right away if you have signs and symptoms of a stroke like changes in vision; confusion; trouble speaking or understanding; severe headaches; sudden numbness or weakness of the face, arm or leg; trouble walking; dizziness; loss of balance or coordination. Call your doctor right away if you have signs and symptoms of serotonin syndrome like irritable; confusion; diarrhea; fast or irregular heartbeat; muscle twitching; stiff muscles; trouble walking; sweating; high fever; seizures; chills; vomiting. You can read more about eletriptan’s side effects, warnings, and precautions here. Full prescribing information for eletriptan is available here. You can read more about naratriptan’s side effects, warnings, and precautions here. Full prescribing information for naratriptan is available here. You can read more about zolmitriptan’s side effects, warnings, and precautions here. Full prescribing information for zolmitriptan is available here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: https://www.fda.gov/Safety/MedWatch/default.htm or call 1-800-FDA-1088.
Sumatriptan and rizatriptan are oral medications indicated for the acute treatment of migraine with or without aura in adults and not for the prophylactic therapy of migraine attacks or for the treatment of cluster headache. Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using either of these drugs while you are pregnant. Tell your doctor if you are breast-feeding. Call your doctor right away if you have chest, throat, neck, or jaw tightness, pain, pressure, or heaviness; break out in a cold sweat; shortness of breath; a fast heartbeat; a heartbeat that does not feel normal; or very bad dizziness or passing out. Very bad and sometimes deadly brain blood vessel problems like stroke have rarely happened with this drug. Call your doctor right away if you have weakness on 1 side of the body, trouble speaking or thinking, change in balance, drooping on 1 side of the face, or change in eyesight. You can read more about sumatriptan’s side effects, warnings, and precautions here. Full prescribing information for sumatriptan is available here. You can read more about Rizatriptan side effects, warnings, and precautions here. Full prescribing information for rizatriptan is available here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: https://www.fda.gov/Safety/MedWatch/default.htm or call 1-800-FDA-1088.
Photo by Roksolana Zasiadko on Unsplash.
