Understanding your medications: Triptans

What are triptans?

Migraine headaches are treated using a variety of medications, sometimes alone, or sometimes in combination with each other. One group of medications, called triptans, is often used to treat debilitating recurring migraine headaches, and work in a unique way. Rather than trying to temporarily relieve headache pain, triptans work to abort (or stop) migraine symptoms.

When taken at the first sign of a headache, triptans have been shown to be able to abort more than 80 percent of migraine headaches in two hours. That is why triptans were considered a medical breakthrough when they were introduced in 1992, and have been somewhat of a miracle drug for millions of people who suffer from moderate to severe migraines.

With such an effective medication available to treat migraines, it is important for people who are experiencing migraine-like symptoms or taking migraine medication that isn’t working for them to see their physician. It may sound surprising, but 50 percent of migraine sufferers do not seek medical attention for their headaches, and treat themselves with over-the-counter medications, which often have limited capabilities. Triptans are often prescribed after patients take non-steroidal anti-inflammatory drugs, or non-prescription medications without success, or when they stop working after regular use. Your physician can determine if triptans should be part of your treatment program.

How do triptans work?

Migraine headache pain is thought to be caused in part by the swelling of blood vessels on the surface of the brain and the release of chemicals that act as pain messengers. Triptans target the brain chemical serotonin found on blood vessels that plays a key role in transmitting migraine pain. By changing the actions of serotonin, it causes the vessels to shrink and also stops the release of other pain-producing chemicals.

Types of triptans and how they are used

There are seven different triptan medications that fall into two categories. The faster acting triptans work in 30 to 45 minutes and the slower acting ones take two to four hours. They also have varying lengths of action. All triptans usually work best when they are taken as soon as migraine symptoms start.

When it comes to triptan medications, faster isn’t always better. Each triptan type has its benefits and drawbacks. Studies show that the faster acting triptans are more effective at stopping headaches, while the slower acting triptans may be more effective at preventing the return of headaches for 24 hours. In addition, some patients experience fewer side effects with the slower acting medications.

The response to triptans varies greatly with each individual. Your physician can work with you to find which triptan works best for your symptoms and headache patterns. That can mean trying several triptans until you find the right one.

Sometimes different triptans can be taken in rotation with each other; for example, you might start with a fast acting triptan to treat your first headache, and then take a slow acting triptan to treat the next headache in a particular cycle. The slow acting triptans may be a good choice for people whose headaches come on gradually or who have frequent headaches. Some triptans are available in different forms–injection, nasal spray or dissolvable tablets–that are easier on the stomach if nausea with migraines is a problem.

Physicians usually recommend using triptans no more than two to three times a week. As with any medication, it is very important to take triptans only as prescribed by your doctor. If triptans (or any migraine medication) are taken more often than recommended, they can cause medication overuse or “rebound” headaches. However, there are exceptions: women who get migraines for several days in a row during their periods can take triptan medication more often for that week only. Fortunately, triptans typically don’t lose their effectiveness over years of use.

What are the side effects?

The most common triptan side effects are facial flushing (redness), heat sensations, numbness and tingling, and tightness in the jaw and upper chest. Some side effects such as dizziness, tiredness and nausea are similar to migraine symptoms. Fortunately, none of these side effects are considered serious and all pass quickly.

Since triptans work by causing the blood vessels to shrink, they may also cause the arteries of the heart to temporarily contract, and therefore they can present a risk for people with coronary artery disease, hypertension, hardening of the arteries or a history of heart attacks or strokes. If you have any of these conditions, your health care provider can decide if triptans are an appropriate choice for you. As part of a medication evaluation, your physician should examine you for cardiovascular risk factors, such as high blood pressure or high cholesterol. Patients at risk sometimes take their first dose at their doctor’s office while their blood pressure and respiration are monitored.

For people who can’t take triptans, or need to take medication more than three times a week, there are many other migraine medications and treatment options, including biofeedback and stress reduction. Your physician can help you find the treatments that are right for your individual needs.

References

MedLinePlus Health Information (2008). Triptans. Retrieved June 20, 2008 from http://www.nlm.nih.gov/medlineplus/

Young, W. & Silberstein, S. (2004). Migraine and Other Headaches. New York, NY: AAN Press