Best Triptan for Migraine: Abort Attacks with the Right Medication

Written and verified by Holly Hazen

If you're battling migraine, you're not alone. Migraine attacks can be a real nightmare, but there's hope on the horizon. Let me introduce you to the superhero family of migraine medications: triptans! In this article, we'll explore how triptans work, which ones might be the best triptan for migraine relief, and how to navigate potential side effects and contraindications.

The Best Triptan for Migraine is....

Sumatriptan, the pioneering triptan, hit the market in the early 1990s, ushering in a new era of migraine treatment. Imigran (Imitrex), manufactured by GlaxoSmithKline, was the first one approved in Australia in 2004. Surprisingly, it took two years for some patients to discover this game-changing medication, which many still consider the best triptan for migraine.

Triptans have been a godsend for many, delivering quick and powerful relief from the crippling pain of migraine attacks. However, their introduction wasn't without controversy. Some patients, me included, were initially outraged that our doctors hadn't informed us about this groundbreaking treatment sooner.

Ironically, it was a client, not a medical professional, who first introduced me to the triptan Naramig in 2006. She raved about its effectiveness for pain relief, and I quickly became a convert. But boy were they hard to get. I needed a special authority script from my doctor and then had 3 hours to fulfill the script. A limited amount per month meant I had to pick and choose which attack to use one with. 20 of 30 days each month... it was challenging.

Triptans have undoubtedly transformed the lives of countless migraine sufferers, but they're not without contraindications. It's essential to understand the potential risks and limitations of these medications, ensuring they're a safe and suitable option for you.

Today, with the wealth of information available online, it's easier for you to stay informed about the latest treatments. However, caution is advised when navigating the internet's vast medical resources. Always consult with your physician before making any changes to your treatment plan.

How Triptans Work Their Magic

Triptans are the superheroes of migraine treatment, designed to quickly combat debilitating symptoms by:

• Decreasing inflammation in the brain's blood vessels, the source of migraine pain

• Blocking the release of pain-signaling chemicals from nerve endings

• Preventing the transmission of pain signals from the brain's lining to the brain itself
  
  

Studies have shown that the best triptan for migraine, such as Frova (Frovatriptan) and Imitrex (Sumatriptan), can provide a 50-60% reduction in migraine pain 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. Frova is also the best triptan for menstrual migraine. More details are below. 

If you haven't tried one of these medications and you're still suffering from severe or frequent migraine attacks, it might be worth discussing with your doctor to see if a triptan could be the best option for you.

>> How To Work with Your Doctor on Medication Selection

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The Science Behind the Relief

For those curious about the science, here's a quote from Emergency Medicine:

"Triptans are believed to alleviate migraine by binding to 5HT-1D receptors, stopping the release of neuropeptides at the trigeminal vascular junction. They also bind to 5HT-1B receptors in the cerebral meningeal vessels, preventing sterile inflammation. Additionally, they may act on central 5HT-1D receptors to limit pain transmission and associated symptoms like nausea, vomiting, light and sound sensitivity, and cognitive impairment."

Expectations and Timing: Key to Success

When taken at the earliest warning signs, while the migraine is still mild, the best triptan for migraine can offer:

• Pain relief within 2-4 hours

• No migraine recurrence within 24 hours

• Return to full functionality within 2-4 hours

• Minimal or no side effects
  
  

Timing is crucial, as some triptans take longer to take effect. For instance, Naramig, the longest-acting triptan, requires a 2-hour window. Understanding your migraine patterns and consulting with your doctor is essential for optimal timing and safety.

Remember, triptans are not a one-size-fits-all solution, and acute intervention strategies may vary based on migraine severity and frequency. Always discuss your medical history with your doctor to ensure triptans are a safe option for you.

>> The List of Options

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Your A-Z List of Triptans for Migraine

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.

(The name-brand version of this drug is no longer available in the U.S., but generic forms are still in use.)

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”.

** One of the best triptans for vestibular migraine **

Eletriptan (at a 40-milligram dose) has been found to be the most effective compared to other oral triptans. It helped 78% of the time. Naratriptan, on the other hand, had the lowest effectiveness among oral triptans. Other triptans like Sumatriptan (Imitrex) and Zolmitriptan (Zomig) were helpful 72% and 74% of the time, respectively. _[5]

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.

** Frova is the best triptan for menstrual migraine **

Naratriptan (Naramig®, Amerge®)

Naramig is my savior. Hail this almighty drug! I was worried about 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 you. 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 cannot 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®, Onzetra®, Tosymra®)

Different doses are available – oral tablets 25, 50, and 100 mgs.
Different Delivery Forms – oral tablets, nasal spray or powder, and subcutaneous 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 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.

Common Side Effects: The Flip Side

According to the American Headache Society, potential side effects of triptans include:

• Chest, neck or jaw tightness

• Pressure sensation

• Rapid heart rate

• Fatigue

• Numbness or tingling (especially on the face)

• Burning sensation on the skin
  
  

Taking triptans early in a migraine attack can reduce the likelihood of these side effects.

Contraindications: When Triptans are Off-Limits

A history of, or co-existing medical conditions may prevent you from using triptans:

• Coronary heart disease

• Stroke history

• Uncontrolled high blood pressure or hypertension

• Diabetes
  
  

Triptans for hemiplegic migraine are NOT recommended.
Triptans and ergotamines are currently not recommended for hemiplegic migraine treatment because they constrict blood vessels and increase the risk of stroke.

Always discuss any potential drug interactions or contraindications with your doctor, including those involving ergotamine, selective serotonin reuptake inhibitors (SSRIs), and even supplements.

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.

Beyond Medication: A Comprehensive Approach

For optimal migraine management, consider combining the best triptan for migraine with complementary therapies:

• Mild attacks may respond to alternative therapies alone

• Severe episodes may require a multi-pronged approach
  
  

Explore self-care strategies, such as those outlined in my Migraine Pain Management Course. Using techniques like using ice and heat alongside your best triptan for migraine can also help abort attacks.

>> My Migraine Pain Management Course

>> How to Treat Migraine with Ice and Heat

Remember, finding the best triptan for migraine relief may require persistence and trying different options or delivery methods. Don't lose hope – effective relief is within reach.

Stay connected for ongoing support on your journey to a pain-free life. >> Join the mailing list 

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How to be more migraine savvy right now...

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<sub>Best Triptan for Migraine References:
1. Glaxosmithkline 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 Triptan Therapy for Acute Migraine Headache. Available at: https://www.americanheadachesociety.org PDF Accessed May 30, 2011.
5. What Is the Best Treatment for Vestibular Migraine? https://www.migraineagain.com/vestibular-migraine-treatments/ Accessed June 1, 2024.
6. Cleveland Clinic. Triptans. https://my.clevelandclinic.org/health/treatments/24998-triptans Accessed June 2, 2024.</sub>