Comparing Triptans

Dean L.

Publication Details

A migraine is a severe headache that is often accompanied by nausea, vomiting, and visual disturbances. The management of migraines involves avoiding known triggers where possible, and using medications that either prevent an attack or shorten it.

Triptans shorten the duration of a migraine. They can be taken in several different ways, for example, sumatriptan can be taken orally as a conventional tablet, a reformulated (rapid release) tablet, a nasal spray, or as a subcutaneous injection.

Although the cause of migraine is not understood, triptans are thought to shorten a migraine attack by constricting blood vessels and preventing the release of pro-inflammatory neuropeptides.

The "Drug Class Review on Triptans" compares the safety and effectiveness of eight drugs. A summary of the findings is below.

How do triptans compare in treating migraines?

In terms of patients being pain free at 2 hours:

In terms of patients with sustained freedom from pain at 24 hours:

For comparisons of other triptans and treatment outcomes, such as normal functioning, quality of life, rate of recurrence, patient preference and satisfaction, please see the full review.

How do triptans compare in safety?

The adverse effects of triptans include chest tightness and central nervous system symptoms such as dizziness, numbness, tingling, and drowsiness. The following drugs do not differ in causing these adverse effects and are tolerated equally well by patients: almotriptan, eletriptan, naratriptan, rizatriptan (oral tablet and orally disintegrating tablet), sumatriptan (conventional oral tablet), zolmitriptan (oral tablet, orally disintegrating tablet, and nasal spray).

Less evidence exists for frovatriptan and sumatriptan (reformulated form, injection, and nasal spray). [full review]

How do combination triptans compare in treating migraines and in safety?

Treximet is a combination drug that contains 85 mg of reformulated sumatriptan and 500 mg of the pain reliever naproxen in a single tablet.

Treximet is superior to reformulated sumatriptan (85 mg) alone in terms of resulting in more patients being pain-free at 2 hours, having sustained freedom from pain at 24 hours, and improving normal functioning, overall productivity, and patient satisfaction. In addition, there is no difference in the overall rate of adverse events. [full review]

Does age, gender, or race influence the safety or effectiveness of triptans?

There is no evidence that one of the triptans is superior (or inferior) to the others in patients of different ages, gender, or race. [full review]

Drugs included in this review

Further information

Image th-triptans09.jpgThis PubMed Clinical Q&A was reviewed by Kimberly Peterson, MS.

For the full report and evidence tables, please see:
Helfand M, Peterson K. Drug Class Review: Triptans: Final Report Update 4 [Internet]. Portland (OR): Oregon Health & Science University; 2009 Jun. Available at: http://www.ncbi.nlm.nih.gov/books/NBK47287/.