The substance has been in place since 1993
- Sumatriptan
It was the first so-called selective serotonin agonist available for migraine therapy. Today, the following other active ingredients from this class of substances are available:
- Naratriptan
- Zolmitriptan
- Eletriptan
- Almotriptan
- Rizatriptan
- Frovatriptan
Since triptans not only combat migraine headaches but also alleviate accompanying symptoms such as nausea, vomiting, and sensitivity to noise and light, the additional use of an antiemetic (medication for nausea and vomiting) is sometimes unnecessary. However, in severe attacks, the stomach muscles are so impaired in their motility that the triptan cannot be transported into the intestines. In this case, it is still recommended to administer an antiemetic (metoclopramide, domperidone) approximately 15 minutes before taking the triptan.
A key effect of triptans is that they block the release of neurotransmitters (neuropeptides and neurotransmitters) that can trigger local neurogenic inflammation in the blood vessels of the brain. Furthermore, during a migraine attack, triptans can normalize the increased nerve activity in various brain centers and narrow dilated arteriovenous fistulas (anastomoses), thereby normalizing the brain's oxygen supply.
While pain medications act throughout the body, triptans essentially bind specifically and selectively to the receptors (5-HT1B and 1D receptors) that are located in the exact areas of the brain where the disease processes of migraine take place.
Important rules for all triptans
- Triptans should only be used after a medical examination, including blood pressure measurement and electrocardiogram, as well as individual consultation. This applies especially to first-time use in emergency situations involving severe migraine attacks.
- They should not be used if there is persistent headache due to medication overuse, or if there are contraindications, such as a history of heart attack, stroke, other vascular diseases, high blood pressure, liver or kidney disease.
- Only take triptans once the headache phase begins, and then as early as possible. These medications should not be administered during the aura phase. This is because they are unable to directly influence the symptoms of the aura. Furthermore, they cannot effectively improve migraine symptoms if given too early before the headache phase. Additionally, a constriction of certain blood vessels in the brain is suspected as a possible cause during the aura phase. Vasoconstrictors such as triptans can therefore worsen symptoms during this phase.
- Triptans must never be administered in combination with ergotamines. Since both ergotamines and triptans cause vasoconstriction, the combined effect of the two drugs can lead to a dangerous additive effect. However, as ergotamines are largely obsolete in migraine therapy, this problem is unlikely to occur. This might only apply to patients with cluster headaches who, in exceptional cases, may use ergotamines.
- Because triptans have a limited duration of action, approximately 30 percent of treated patients experience a recurrence of migraine symptoms after the medication wears off. This so-called rebound headache can be successfully treated with another dose. Important: This does not mean that the migraine attack is postponed or prolonged! As a general rule, the dose can be repeated once a day. If you take the medication more than twice a day, you should work with your doctor to develop a new treatment plan that leads to better effectiveness. In such cases, choosing a long-acting triptan, such as almotriptan, naratriptan, or frovatriptan, is recommended. Combining triptans with a long-acting COX-2 inhibitor (e.g., Arcoxia 120 mg) or an NSAID (e.g., naproxen 500 mg) can also reduce the likelihood of rebound headaches.
- Regardless of the dose, you should make sure that you do not take the medication for more than 10 days per month, otherwise there is a risk of chronic headaches due to medication overuse.
- Patients with a high attack frequency are often unsure whether they should take their triptan as soon as a headache begins. They face a dilemma: on the one hand, they should take the medication very early in an attack, and on the other hand, they must be careful not to exceed the limit of 10 days per month. For this reason, a checklist, the so-called "triptan threshold" (see download box top right), has been developed to help determine the precise time of administration for each individual.
- The manufacturer recommends administering triptans only up to the age of 65. However, in consultation with the treating physician and after a cardiological evaluation, there is no contraindication to using triptans beyond this age. Studies are now also available on the use of sumatriptan and zolmitriptan as nasal sprays in adolescents between the ages of 12 and 18. These studies showed no increased risk in this age group. However, triptans should not be administered to children under the age of 12.
- Typical side effects of triptans include mild, general weakness, dizziness, paresthesia (abnormal sensations such as tingling, a feeling of warmth or heat), and mild nausea. Very rarely, tightness in the chest and throat may also occur. As a rule, the side effects are mild and disappear on their own.