What Is Triptan?

Triptans are a class of drugs used to treat acute migraine attacks. Collectively, triptans are selective serotonin receptor agonists, which means they stimulate production of serotonin, a neurotransmitter that reduces inflammation and constricts blood vessels. These actions stop the migraine process and end the intense pain, nausea and sensitivity caused by migraines.

What is Migraine

• To understand how triptans relieve migraines, it is necessary to understand the migraine process. Migraines begin when a trigger event - such as lack of sleep, certain foods, allergies, hormone fluctuations or weather changes - causes blood vessels in the brain to constrict. This vasoconstriction causes the aura that typically precedes a migraine in some people. The aura consists of flashing lights or spots before the eyes, tingling in the hands or face or a coppery taste. The constricted blood vessels then expand (vasodilation) and press against the trigeminal nerve, causing the intense, throbbing pain that characterizes a migraine. Without treatment, migraines typically last from three hours to three or four days.

How Triptans Work

• Triptans are intended for acute migraine treatment, which means they are most effective when taken early in a migraine attack. Triptans, also called 5HT1 agonists, stimulate the production of serotonin and block the release of other neurotransmitters that play a role in the transmission of pain. Triptans are vasoconstrictors, causing the dilated blood vessels to return to their normal diameter and relieving the pressure on neighboring nerves.

Benefits of Triptans

• Triptans stop the migraine process, preventing the migraine from becoming worse and shortening the duration of the attack. Triptans are not pain relievers; they are ineffective on non-migraine headaches. Triptans are effective because they interrupt the migraine process and relieve not only the pain but also the accompanying symptoms of nausea, vomiting and sensitivity to light and sound. Analgesics such as ibuprofen, acetaminophen, naprosyn and aspirin are less effective against migraine. Although they temporarily relieve the pain, a single migraine attack can last up to four days so the migraine symptoms return when the analgesic wears off.

Side Effects

• Seven triptans are available in the United States: sumatriptan (Imitrex), zolmitriptan (Zomig), naratriptan (Amerge), rizatriptan (Maxalt), frovatriptan (Frova), eletriptan (Relpax), and almotriptan (Axert). Although all have a similar mechanism, each triptan binds to a different combination of serotonin receptors, resulting in differences in effectiveness, onset of relief and side effects. Some side effects, however, are common to all triptans. Because triptans are vasoconstrictors, they may elevate blood pressure. Patients with cardiac disease should avoid triptans, and triptans should be used with caution in people who have a family history of heart disease or who have other risk factors for heart disease. Other side effects common to all triptans include dizziness, drowsiness, dry mouth and skin tingling. Triptans may also be associated with chest pain or tightness or pounding heart.

Drawbacks of Triptans

• Triptans effectively relieve migraine pain and associated symptoms, but they are expensive and available only by prescription. However, patents are beginning to expire and less expensive generic versions are becoming available. Triptans are not intended to be used for migraine prevention; that is, before a migraine starts. For patients who have frequent migraines (more than three per month), low dose antidepressants or antiseizure medication may be used daily for migraine prevention.