Triptans
Triptans are a class of drugs known as serotonin receptor agonists. They were specifically designed as migraine therapy, and are the most commonly prescribe migraine medication today. Serotonin is a neurotransmitter, or brain chemical, that helps to regulate mood, appetite, sleep, and other brain/body functions. Triptans work by inhibiting the transmission of signals in certain nerve centers of the brainstem, and in doing so they seem to be able to terminate or reduce the complicated cascade of inflammation and vascular changes going on in the head that are associated with migraine head pain and migraine-related nausea, vomiting, and photophobia (sensitivity to light).
If you take antidepressants, talk to your doctor before taking a triptan drug. Selective serotonin reuptake inhibitors (SSRI) and selective serotonin/norepinephrine reuptake inhibitors (SNRI) are antidepressants that interact with triptans, and a life-threatening condition called serotonin syndrome can occur, though rarely, in patients taking both drugs.
The triptans include sumatriptan succinate (Imitrex), zolmitriptan (Zomig), eletriptan hydrobromide (Relpax), naratriptan hydrochloride (Amerge, Naramig), rizatriptan (Maxalt), frovatriptan succinate (Frova), and almotriptan malate (Axert). These drugs are available in various formulations, including oral drugs, nasal sprays, and injections (depending on the type of triptan). The injectable form is frequently prescribed for those migraineurs who experience severe vomiting during a migraine attack.
Triptan drugs work best when they are taken as soon as a migraine attack begins. Taking a triptan early also reduces side effects and decreases the chance of migraine recurring in the next twenty-four hours. Studies show that on average, triptans abort up to 80 percent of migraine headaches within two hours. Triptans can sometimes be used as a preventative, or prophylactic medication, particularly in the case of menstrual migraine. Chapter 8 has more details on triptans as prophylactics.
People who take an SSRI, SNRI, or monoamine oxidase (MAO) inhibitor should not take triptans without discussing risks carefully with their doctor, as these combinations can rarely cause serious and even life-threatening interactions. Triptans should also not be taken with ergot derivatives (see previous section). Triptans can also cause some mild side effects including:
Flushing of the skin
Tingling of the skin
Tightness in the chest and/or throat
Drowsiness or fatigue
Dizziness
Muscle weakness
Burning at injection site (for injectable sumatriptan)
People who have a history of heart attack, stroke, angina, or atherosclerosis should not take triptans because triptans can constrict blood vessels. These drugs are not approved for use in pregnant women or in children under age eighteen, although they are sometimes prescribed for adolescents on an “off-label” basis when other treatment methods fail.
