Neurology
Triptans
Acute migraine drugs — Targeted treatments that stop a migraine attack once it has started.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
What it is
Triptans are used to treat acute migraine attacks — and sometimes cluster headache — by acting on the specific mechanisms of a migraine rather than just masking pain. They do not prevent attacks.
How it works
They stimulate particular serotonin (5-HT) receptors, which narrows the dilated blood vessels involved in migraine and dampens the release of the inflammatory signals that drive the pain. This targeted action is why they relieve migraine specifically, and also why they carry cardiovascular cautions.
In practice
In practice triptans are the specific treatment for a migraine attack (as opposed to prevention), and they work best taken early, as the headache begins, rather than waiting. A practical point is that if one triptan does not help, another may — response is individual, and there are several to try, including a nasal spray or injectable form for people who vomit early. The main cautions stem from their blood-vessel-narrowing action: they are avoided in significant cardiovascular disease, uncontrolled hypertension and certain other vascular conditions. Using any acute migraine treatment too often (including triptans and simple painkillers) can paradoxically cause medication-overuse headache, so frequency is reviewed and frequent attacks prompt a move to preventive treatment.
Examples
Practical use
How to take it & use it well
- Take a triptan such as sumatriptan as soon as the migraine headache starts, not at the first warning aura, for the best effect.
- It is for treating attacks, not preventing them; do not use it for ordinary tension headaches.
- If one dose does not help that attack, do not take a second for the same headache unless your information leaflet says you may; follow the daily limit.
- Limit how many days a month you use it, because frequent use can lead to medication-overuse headache.
- Tell your clinician about any heart problems, stroke, uncontrolled blood pressure or circulation conditions before using, as triptans narrow blood vessels.
Common uses
- Acute migraine attacks
- Cluster headache (e.g. injectable/nasal sumatriptan)
Monitoring
- Attack response and number of treatment days per month
- Blood pressure and cardiovascular risk
- Whether preventive treatment is now needed
Weighing it up
Advantages & disadvantages
Advantages
- Often relieves migraine pain and associated nausea and light sensitivity within hours.
- Available in different forms, including tablets, nasal sprays and injections, useful if vomiting prevents swallowing.
- Designed specifically for migraine, so often more effective than ordinary painkillers for moderate to severe attacks.
- Can let people return to normal activities faster during an attack.
Disadvantages
- Not suitable for people with certain heart, circulation or stroke conditions because they narrow blood vessels.
- Can cause tightness or pressure in the chest, throat or jaw, tingling, flushing and drowsiness.
- Using them too often can cause rebound, medication-overuse headaches.
- Do not treat the underlying tendency to migraine, so frequent attacks may need preventive treatment as well.
Key safety principles
What to watch for
- Avoid in significant coronary or cerebrovascular disease, uncontrolled hypertension and some other vascular conditions (vasoconstrictor action).
- Overuse can cause medication-overuse headache — limit treatment days and review frequent use.
- Caution combining with other strongly serotonergic drugs.
Key interactions
What to avoid or check alongside
- Other triptans or ergotamine-type migraine medicines: combining them increases the risk of excessive blood-vessel narrowing, so timing must be separated.
- Certain antidepressants (SSRIs and SNRIs): a small risk of serotonin syndrome, so report agitation, sweating, tremor or confusion.
- Some MAO inhibitor antidepressants: can raise levels of certain triptans and are best avoided together.
- Medicines that affect blood pressure or circulation: combined effects should be considered in people with vascular risk.
Patient & carer advice
- Take it as soon as the headache phase of the migraine starts
- If one triptan does not work, another might — tell us
- Using acute treatments on too many days can make headaches worse — keep track
Use with
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Answers
Triptans: frequently asked questions
When should I take a triptan?
Take it as soon as the migraine headache begins, rather than waiting. If you experience an aura, it is generally taken when the headache starts, not during the aura. It treats attacks and does not prevent them.
Why are triptans not for everyone?
Triptans work partly by narrowing blood vessels, so they are not suitable for people with certain heart conditions, previous stroke, uncontrolled high blood pressure or some circulation problems. Tell your clinician about your medical history first.
What is medication-overuse headache?
Using acute migraine treatments, including triptans, on too many days each month can paradoxically cause more frequent headaches. Keeping use within recommended limits and considering preventive treatment helps avoid this.
Can I take a triptan with my antidepressant?
Some antidepressants can be combined with triptans but there is a small risk of serotonin syndrome. Tell your clinician about all your medicines, and seek advice if you develop agitation, sweating, shivering, tremor or confusion.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
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