Hail the Almighty Triptan!

Sumatriptan was the first triptan targeted for migraines that was released between 1991 and 1993. Imigran was the first one on the market that I heard about in 2006 and it was approved by the Therapeutic Goods Administration (TGA) on July 30, 2004.

That is fast, only two years for me to hear about it.

Glaxo Smith Kline Pty Ltd is the company that makes Imigran (Imitrex).

Their website has a wealth of information on each drug they manufacture including – yes you guessed it – the most effective class of “designer drugs” for aborting migraine episodes.

The website also has product information – intended for health care professionals – that includes their clinical trials. Thank God for the internet. But I urge to read with caution. Make sure you are on reputable sites and always discuss things over with your physician before making any changes. 

Having said that, one of my clients told me about Naramig in 2006. Not any of specialists or doctors I was seeing, a client who had back surgery. She used it for her back pain and took one everyday to ease the pain. She swore by its efficacy. 

And now so do I.

Basic Info – How They Work

Hail the Almighty Triptan!

According to WebMD.com these medications work to:

decrease inflammation of our blood vessels in the brain causing the pain;

block the release of chemicals in the nerve endings;

and prevent the pain signals transmitting from the lining of the brain to the brain itself. 

The perfect abortive medication.

They cite a few very promising studies done with Frova (Frovatriptan) and Imitrex (Sumatriptan) resulting in a 50-60% reduction within two hours and the side effects of nausea, dizziness and fatigue were found similar to those taking the placebo. I think those are amazing results really. 

If you haven’t tried one of these medications and you are still suffering from severe or frequent migraine attacks it might be worth a phone call and a trip to your doctor to discuss if this may be an option for you.

Let’s Get Straight to the Details

If you need more details on how they work – here is a direct quote from Emergency Medicine. I am not even going to try and interpret this....

“Triptans are believed to alleviate migraine by several mechanisms. By binding to 5HT-1D receptors, the medication stops the release of neuropeptides at the trigeminal vascular junction. The cerebral meningeal vessels contain 5HT-1B receptors, which when triggered will produce sterile inflammation."

"The triptans bind to these receptors and stop the sterile inflammation of meningeal arteries. In addition, this medication may act on central 5HT-1D receptors to limit pain transmission and associated migraine symptoms, such as nausea, vomiting, light and sound sensitivity, and cognitive impairment”.

What You Should Expect

If you take this prescribed medication at your earliest warning signal, or symptom, while it is still in the mild phase (according to the American Headache Society) then you can expect:

  • To be pain free within 2 to 4 hours of taking the prescribed medication; (tick)
  • No recurrence of migraine within 24 hours of becoming pain free; (no tick)
  • To return to full functioning within 2 to 4 hours after taking the medication; (no tick)
  • No side effects or minimal side effects. (tick)

I achieve 2 out of 4 of these, so that's not bad in my opinion. I am not sure if the AHS has wishful thinking or some of us actually achieve this state of migraine freedom. Do you?

Acute intervention strategies will vary between individuals. Mild, intermittent migraines will be treated differently than severe or chronic migraines. How long it takes for your migraine to come on is important too.

For example, Naramig is the longest acting medication from this list, but it takes 2 hours to take effect.

Discuss all of this with your Doctor.




Triptan Medication Disclaimer

Warning - individuals should also be advised against using triptans more than three times a week, unless they are being used specifically for menstrual migraine prevention.

They are not recommended for use (contraindicated) in pregnancy and in individuals with cardiovascular problems. They should also be used with extreme caution or in some cases not at all to treat basilar migraine and migraine with prolonged aura.




The Triptans A – Z

Triptan

• Almotriptan (Axert®)

Preferred dose – 12.5 mgs
Form - oral
Onset of action – 2 hours

This is the least expensive one of the lot and after the individual becomes pain free within the 2 hours, the migraine rarely recurs. Studies show 39% of participants sustained a pain free response rate over multiple attacks.

• Eletriptan (Relpax®)

Preferred dose – 40 mgs
Form – oral
Onset of action – less than 30 minutes

This drug was approved in 2002 and has been available since 2003, it has an effect on eletriptan levels in the brain (emedmag.com). “This important enzymatic system also is responsible for the metabolism of drugs that may significantly increase eletriptan levels in the brain. Both the peripheral and central nervous system effects of it can be increased”. They go further to say that there is still limited data available to assess the true potential risk increasing these levels.

This medication has an interesting warning that “Patients should be advised that drinking grapefruit juice while taking" it as it "can increase cerebral blood levels of the drug. The drug does not interact with monoamine oxidase inhibitors”.

• Frovatriptan (Frova®)

Preferred dose – 2.5 mgs
Form – oral
Onset of action – 2 to 4 hours with half life of 6 hours

This one has a half life of 6 hours and has a lower headache recurrence rate than the other triptans except for naratriptan. It has a slower onset of action and may be more useful for migraines that develop slowly and last longer. It has minimal warnings will little potential for interactions with other drugs. It is recommended for menstrual migraines.


Naramig / Naratriptan

• Naratriptan (Naramig®, Amerge®)

Naramig is my savior. Hail this almighty drug! I was worried abut long term use, but just the other day I heard an interview where the studies were now finding that long term use with these medications were actually found to reduce migraines more effectively over time. The study was done over a 6 year period. I wish I had caught the details so I could quote it for us. But for now, just know that this classification of medications is very effective for migraines.

Preferred dose – 2.5 mgs
Form – oral
Onset of action – 2 to 4 hours with half life of 25 hours

Naratriptan has a half life of 25 hours and has a lower headache recurrence rate than other triptans except for frovatriptan. The onset of action is slightly slower than that of the short acting triptans, so it is more useful for migraines that slowly come on and have long duration (like mine!).

There is minimum potential for interaction with other drugs. This medication has been proven to be most effective when taken at your earliest warning signal that your migraine is starting. It is also recommended for treating individuals that have migraines associated with menstruation.

• Rizatriptan (Maxalt®)

Preferred dose – 10 mgs
Form – oral wafer (disintegrating tablet)
Onset of action – 2 hours or less

Maxalt disintegrates on or under your tongue. It's nice it just dissolves and tastes like peppermint. It is used for migraineurs that experience nausea as an early symptom and can not take medications without vomiting them up.

Maxalt did not work for me. I had to take too many for just one migraine. And I started vomiting again ... not good. Just not for me.

• Sumatriptan (Imitrex®, Imigran®)

Different doses are available – oral tablets 25, 50, and 100 mgs.
Different Delivery Forms – Oral tablets, nasal spray, and injection.
Onset of action – 2 hours, less than 15 minutes for nasal spray and injection.

Sumatriptan is available in three forms - self-injection, nasal spray and rapidly dissolving tablets. The injection provides the fastest onset of action of all the triptans. The tablets at 50 and 100 mg doses eliminate migraine pain in over 60% of migraineurs within the two hour time period.

It is also found to help reduce migraine induced cognitive impairment. The injection form is most useful for migraine attacks that come on quickly and are accompanied with severe nausea and vomiting. The injection formulation is for instant intervention.

Imigran has strong side effects for me. Heart palpitations and confusion, but boy did it work well long term. It aborted the migraine after I passed out and felt euphoric upon waking. If I didn’t know better I’d give this one a another trial after all these years, but I am sure I will have the same response.

Wouldn't it be nice to feel better after a migraine instead of hung over! Ah but to dream!


• Sumatriptan and Naproxen Sodium (Treximet™)

Dose – 85 mgs of Sumatriptan and 500 mgs of Naproxen Sodium
Form – oral tablet
Onset of action – 2 hours or less

Treximet contains both Sumatriptan and Naproxen sodium which is a non steroidal anti-inflammatory drug (NSAID). There are strong warnings that this may increase the chance of a heart attack or stroke and this chance increases with longer use of NSAID medicines.

Contraindications for people with a health history of heart disease, liver disease, stroke, high blood pressure, kidney problems, stomach ulcers or bleeding, an allergic reaction to aspirin, NSAIDS or Sumatriptan. Do not take before heart surgery. Do not take if you are pregnant. Do not take if you already take some antidepressants called SSRI’s or SNRI’s.

Do not take Treximet if you have taken an MAOI antidepressant within the last 2 weeks. Ok – there are too many warnings here for me to list. Discuss this thoroughly with your physician / MD before deciding to use this one as an abortive for your migraines.

This medication is not recommended if you have other risk factors for heart disease, high cholesterol, smoking, obesity, diabetes, are a male over the age of 40 or a post menopausal female.

• Zolmitriptan (Zomig®)

Preferred dose – 2.5 mgs (ZMT)
Form – oral tablets, oral “melt”(ZMT), nasal spray
Onset of action – 2 hours for orals and 15 minutes for nasal spray.

Zomig is available in three forms now: nasal spray, oral tablets, and “melt” tablets that disintegrate when placed on top of the tongue. Minimal side effects have been reported. Take this one at the earliest warning sign.

I tried this one – I think the 25 mgs tablet was too potent for me!  Like Imigran, I got heart palpitations and hot flushes and anxious over the scary side effects.

Warning: Zomig is not recommended for the prevention of migraines or for the treatment of hemiplegic or basilar migraines nor is it to be used for other types of headaches.

Triptan Common Side Effects

According to the American Headache Society the potential side effects with this family of medications are: tightness in the chest, neck or jaw, pressure, rapid heart rate, fatigue, numbness or tingling (especially on the face), a burning sensation on the skin.

Interestingly, the side effects have proven to be less likely to occur when these medications are taken early in the migraine attack

Contraindications

A history of, or co-existing medical conditions will prevent you from using this class of medications: Coronary heart disease, strokes, uncontrolled high blood pressure or hypertension and diabetes.

Always discuss any potential drug interactions (aka contraindications) with your doctor.

And get the complete print out from your supplying pharmacist about any contraindications with other medications like ergotamine and selective serotonin re-uptake inhibitors (SSRI's). 

Please be careful, I can’t say that enough.

Even supplements you are taking can have an effect, so make sure your doctor knows everything you are taking.

Ways To Treat Migraines

The Migraine World Summit highlighted that we must combine traditional medications with complementary and alternative therapies to obtain the very best results.

Don't under estimate making healthy choices for yourself.

I have used Biofeedback for migraine reduction for years and different forms of meditation.

How to Treat Migraine with Ice and Heat is the best way to abort an attack if you can. Mine are too stubborn, but this works well for many of us. The ice definitely helps reduce the pain. I use it every time ... it is my number one go to.

I also do yoga and Tai Chi. I take a number of supplements for migraines to support my body and be proactive. 

This combination works very well for me. Click on the links:

Related Articles for Treatment and Prevention

Drug Class Review: Triptans - Drug Effectiveness Review Project, Marian McDonagh, PharmD, Principal Investigator, Oregon Evidence-based Practice Center, Oregon Health & Science University, Mark Helfand, MD, MPH, Director. Portland (OR): Oregon Health & Science University; 2009 Jun.

Botox Injection for Migraine – The FDA approved onabotulinumtoxinA – Botox injection for migraine prevention treatment in October 2010. It is now an officially allowed anti-migraine drug. Be pain free and look great! What more could a girl want? No seriously, the results are quite positive.

Migraine Prescription Medication – Print off our form and use the detailed information to build your own medication treatment strategy with your Doctor.

Migraine Prevention
- What is your role in your own migraine prevention as a migraine sufferer? Do you rely on your Doctor alone for your pain management or have you learned to become your own advocate?

Migraine Prevention Medications - What are prophylactics? Medications that you need to take every day in order to reduce your migraines. Prepare to learn before your doctor’s appointments with this information, or bookmark to come back to after the consult.

Migraine Headache New Treatment Plan – It’s time to develop YOUR Migraine Headache Treatment Strategy. What’s that - you don't have one? You just suffer with them...well then it's time to get started. Let me show you how ...

Myofascial Trigger Points
- Millions of people suffer from migraine headaches. Trigger point therapy is becoming a well known approach you can do yourself or get a treatment from a trained practitioner to get some immediate relief from your migraines. Myofascial trigger point therapy target the insertion points of muscles. Learn more here.

Medication for Migraine - What you need to know about taking your medications for your migraines. For example only seven drugs are approved by the FDA for acute treatment and only four others are approved for migraine prevention at present. They are more and more approved almost daily. Do you know which ones are available to you?

List of Migraine Medications - There is an overwhelming list of migraine medications available to us. I have broken them down into categories so we can see what’s up to date, approved and recommended - not just available for this medical condition.

Whats That? You Want To Read More?

Here are some more articles you might like to read. If you don't see what you'd like here, please use the white Google search bar at the top of the page and the search results should bring up the information you require.

If you still can't find anything please contact me directly and I will see what I can do.


Ok, so this got a bit long. But at least you can see that there are a number of medication options for you to trial. So don't give up ... persevere.

You will find effective pain relief.

Stay in touch by joining the mailing list. Stay well,






References:

1. Glaxo Smith Kline Australia Pty Ltd (2015) Our Prescription Medicines and Vaccines. Available at: http://us.gsk.com/en-us/products/prescription-medicines-and-vaccines/ Accessed on June 2, 2016.

2. WebMD.com (2016) Migraine Treatments. Available at: http://www.webmd.com/migraines-headaches/guide/migraine-treatments Accessed June 27, 2016.

3. Emergency Medicine (2011) Understanding Migraine: Treatment Options. Available at: http://www.emedmag.com/html/pre/fea/features/091503.asp Accessed June 7, 2011.

4. American Headache Society (2006) Patient Information: Oral and Intranasal Trip tan Therapy for Acute Migraine Headache. Available at: https://www.americanheadachesociety.org PDF Accessed May 30, 2011.



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With this new information, what one thing can you do now to reduce your attacks?