Migraine headaches are truly a troublesome problem. Ask anyone who has experienced the pain and other symptoms associated with a migraine episode, and they’ll tell you about it with a facial expression that tells you they’re serious. Migraineur’s, as people with frequent migraine headaches are called, will tell you they will do anything, or take anything, to make the pain go away.
In December, 1992, triptan drugs were introduced to the public. Triptans were a new class of drugs that were more effective than anything existing at that time. The first triptan available was sumatriptan, or Imitrex. It was available, then, only as an injection. That immediately limited its desirability among patients because the migraine sufferer either had to learn to give himself a subcutaneous shot or he had to find a spouse or caregiver who was willing to do it for him. That was a stumbling block for a lot of people. When your head hurts so bad that you want isolation and total quiet, collecting your wits enough to give yourself a shot is very very difficult. Also the injectable form of sumatriptan had multiple very unpleasant side effects that frightened both patients and caregivers, equally. These side effects (chest pain, arrhythmias, hot/cold flashes) occurred immediately after administration and were intense. Fortunately, they disappeared within 20-30 minutes, about the same time the headache went away. But getting to that point could be agonizing.
Injectable Imitrex worked well. But many patients used it only when their migraine was intolerable because the side effects were so unpleasant. Oral sumatriptan wasn’t available until 3 years later, and in my experience didn’t work as well as the injectable formulation.
Since then, multiple other triptans have been developed and entered the market. In fact, there are seven triptans, but like any “first drug on the market,” sumatriptan is the standard to which all, others are compared.The seven triptans are:
Axert (almotriptan)
Relpax (elitriptan)
Frova (frovatriptan)
Amerge (naratriptan)
Maxalt (rizatriptan)
Imitrex (sumatriptan)
Zomig (zolmitriptan)
For years I have thought triptans didn’t get the respect they deserved. I also thought they were underutilized and not taken soon enough after the onset of pain. A huge study in the British Medical Journal, evaluated 89,445 patients who were treated for acute migraine headache. These patients were treated with 17 different drugs “ranging from analgesics to triptans.” Each drug was used as initial treatment, but if relief was not achieved, another of the 17 was tried until headache relief was complete.
The study results showed Triptans, particularly sumatriptan and eletriptan, were the clear winners. These triptans provided “immediate relief of migraine pain” and did not require “rescue medication.” In other words, triptans worked effectively without the need for additional analgesic. Using sumatriptan as the standard, “only eletriptan achieved greater pain relief in 2 hours.” Thirty-year-old sumatriptan, and triptans in general, we’re “more effective than newer treatments including Ubrelvy, Reyvow, Nurtec, and analgesics such as ibuprofen and acetaminophen.”
Dr. G’s Opinion: This study validates my opinion that triptans are more effective than they are given credit and are underutilized. Save your patient some money and yourself some frustration and anguish by prescribing, or if you’re a migraineur, taking triptans for acute migraine headache. If a patient has frequent migraines, I would still try to find a daily medication to take as preventive treatment. Patients can still take a triptan for breakthrough migraines even if they’re on a prophylactic drug. Don’t be hesitant to take a triptan sooner rather than later. They work, and waiting only makes the headache harder to resolve.
Reference: Shaughnessy AF. “Triptans outperform older and newer treatments for acute migraine.” Am Fam Phys 2025 April;111(4):377-378.
Karlsson WK, et al. Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis. BMJ 2024;386:e080107.
