When using Triptans, do you make this mistake?

Triptans, a type of abortive drug for migraine, are taken many different ways.  Some people use a triptan, and only a triptan, every time they have a migraine attack.  Some people alternate with other drugs (due to insurance restrictions or other reasons).  Others start with something else, then turn to the triptan.

But how you do it may make a bigger difference than you think.

In case you’re not sure what we’re talking about, triptans include drugs like naratriptan, almotriptan, eletriptan, frovatriptan, rizatriptan and zolmitriptan.  You might find some of the brand names more familiar – Amerge, Relpax, Frova, Maxalt, Zomig, Zomigon, Almogran and Imitrex to name only a few.

I was looking at some helpful research from Dr. James Banks III, founder of the Carilion Headache Center in Roanoke, Virginia, USA.  He has looked at the impact of how you take your triptans, and what works best.

His findings found that triptans work best when you take them first, every time.  Further, if migraine-specific drugs (such as triptans) are the only drugs you’re taking (as opposed to various painkillers, opioid drugs, etc) they work even better.

Dr. Banks looked at this from a number of different angles, but here’s just one example.  Just how disabled were patients who took triptans first, compared to others?

Google Chart

As you can see here, patients who took triptans first all the time had a far lower level of disability than the others, even when the others sometimes took a triptan first.

Another interesting finding – those who took a triptan first all the time were far less likely to have insomnia and irritable bowel syndrome (IBS).  Those who never took a triptan first were more than three times more likely to end up with one of these other issues.

Generally, those who took triptans early on, at the first sign of pain or when the attack was still mild, were slightly less likely to have comorbid depression or anxiety.

How do you take your triptans?  Why?  We would be interested to hear your responses.

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82 comments… add one
  • Ann Feb 20, 2010

    Maybe if insurance companies, the people who set prices for medications for out-of-pocket purchases, and my doctor (who insists it’s dangerous to take triptans more than 10 times/month) would get the hint, more people like myself could follow these guidelines. I used to see a neurologist who insisted I take triptans, and only triptans at the first sign of a migraine. This neurologist gave me tons of samples to make up for what my insurance would not let me fill.

    Since I moved and no longer see him, I try a variety of different tactics to take fewer triptans. If a migraine is just killing me, I’ll take a triptan right away, but if it’s not, I’ll try something like taking Naproxen first, waiting to see if it’s going to get bad enough for me to have to intervene, or using cold packs (like First+Ice) to dull the pain down to a level I can stand.

  • Andy Feb 20, 2010

    I live in the region of Carilion Clinic. I just wanted to let you know that Dr. Banks has not been with Carilion for some time, and they do not currently have a headache center.

    That doesn’t mean the research is faulty. I think that the research may well prove something to those who can or do use triptans.

  • Tricia Fields Feb 20, 2010

    I’m fortunate enough to be on a prophylactic regimen that has greatly reduced the number of migraines I have. As a result, I always treat my migraines with triptans (Maxalt MLT) because triptans work completely differently than NSAIDS (aspirin, ibuprofen, naproxen, etc). I can never remember which medication is a vasoconstrictor and which is a vasodilator, but I do remember that the triptans work the opposite the way the NSAIDS do, and that’s why they work so well on migraines. So I try to stay away from NSAIDS if I can when I have a migraine, because I’m afraid it might actually make the pain worse. An untried theory on my part, but one I don’t wish to test until I have to.

  • Aurora Feb 21, 2010

    It is difficult for me to decide when to have triptans because of the aura and the numbness of my extremities (usually my left region). I also couldn’t tell if I am having migraine or tension headache because I oftentimes have both at the same time. So I eliminate other types of headaches first with NSAID or opioid prep before I tape the triptan. The result, well…I am still on the drawing board.

  • A.M. Feb 21, 2010

    I take Maxalt every time I get a hint of a migraine and this approach is working for me. In addition I take the lowest dosage of Nortriptilyne daily to prevent migraine. This combination really has helped me. If you can get by on the 5 mg of Maxalt but need more than the insurance allows ask the dr. to prescribe 10 mg, and cut in half. That’s how I have gotten around the insurance limit. Prior to using this method I was always running out and had to wait for a refill and this resulted in some terrible migraines. For me migraine management has come down to consistency of meds, vitamins, no caffieine, a weekly massage, don’t skip meals, no chocolate, and get exercise.

  • James Feb 22, 2010

    Thanks for your comments so far! I should emphasize again that these studies alone are not enough to suggest you should always take triptans. There are a lot of factors, and a lot of controversy about these drugs – that’s a whole other post! However, we all want to make sure that, if we’re taking something, we’re getting the best value. Many people have tried triptans and then decided they just “don’t work”. There are many reasons why that may be… it may be too early to give up on them.

    Andy, thanks for the note on Dr. Banks. I should have realized that – he is with the Ryan Headache Center in St. Louis, MO.

  • Rich Feb 22, 2010

    James –

    Interesting data. Has the full study been published anywhere? I’d be interested in reading….

  • James Feb 23, 2010

    Hi Rich,

    This is actually information drawn from more than one study that Dr. Banks has done. If you want to read more, a lot of his research is available online here.

  • Zachary Ernst Feb 25, 2010

    Some people I know have made the mistake of not taking triptans early in the attack consistently because they have tried one drug (usually Imitrex), found that it doesn’t work as well as they would have hoped, and so they rely on other medications (especially painkillers). So it’s worth bearing in mind that the triptans are quite different from each other, and so it’s crucial to experiment with different triptans until you find one that works well for you.

    • Shannon Mar 29, 2011

      I have had migraines for years and have been to many doctors. I’ve tried everything as well as an MRI! It was not until I met a guy who had cluster headaches and he told me that he uses imitrex injections. I said ha ha nothing works for me, so one day I got yet another dreaded attack and he let me try one……. It was a miracle! I swear this saved my life, the funny thing is that I tried the imitrex nasal spray and tablets before and they did nothing. I asked my doc to prescribe the injectables to me and he had never heard of them before…..

      • Leslie Apr 10, 2012

        I have tried imitrex in all forms, and the injection was the only thing that took care of my migraines. The nasal spray worked for 30 minutes and once I moved my head or looked down, wam! back came the migraine. I got my first Imitrex injection in ’94, and to this day, if I have a horrible migraine, it’s the one thing I know will work. Now there is Treximet, which has imitrex and naproxysn and it is a close second to the imitrex injection.

      • Tom Oct 23, 2015

        It is 3:30 and my wife just woke me and I gave her an imitrex shot (4 ml). It is the only way we go unless she is at work and can take a maxalt. If we miss the window, it is two days of hell and sometimes the ER which is the only way to end the nausea. An injection is the only way, but she only get’s two and they only allow two. I have given her as many as six in 48 hours (I know the argument), but it it was the only think that worked. After 15 minutes now, the attack has ended. The vaso issue and risk must be different for each person, but now one knows the pain caused, so if the risk is a concern, go to the ER, period! They will give a hydromorphine to knock out the pain, and it eliminates the vase risk. It is terrible regardless as there is a post anesthesia headache but at least the migraine is addressesd.

  • Gail Mar 24, 2010

    At the first sign of migraine, I take Excedrin (which used to ALWAYS work alone for my migraines in my youth). Now, usually that is not enough so I wait maybe a half hour and if the headache is not gone by then, I take the Maxalt. Within an hour the migraine is completely gone–USUALLY. If the first sign of the migraine is not mild, then I take the Maxalt and Excedrin TOGETHER at once. This usually does the trick. The reason I use the Excedrin first most of the time is that sometimes the Maxalt alone doesn’t cut it, and because of the expense of the Maxalt.

  • Nikki Albert Apr 13, 2010

    I agree my triptan is my first line of attack, because it has the greatest chance of success in eliminating all symptoms of a migraine. However, I have been told by my neuro to not use more than three times a week, which is rather tricky since I get chronicly chronic migraines lately. I had a doctor once who said to take my triptan always at the first sign of a migraine, I was on zomig at the time, which you can take four times a day, which then I was taking four times a day almost every day… and led to a nasty rebound cycle of always having a headache. So I’ve learned to juggle my medication so as to not use the triptan more than three times a week and not to use the painkiller (tramacet) more than three times a week and hope that covers it. I have found when I forget this rule, the triptan does not have as good an effect when it is over used, as in often it does not fully abort the migraine or the migraine returns a few hours later. Quite frankly I am rather waiting on my preventatives to magically make my migraines way less frequent and thus far easier to treat.

    • ErinDLz Dec 17, 2010

      I think it may be a fair assumption that the triptans are not working for you since you have to take so many so frequently. That’s exactly how my situation was. Most people find great relief with one dose and rarely need additional doses… so since we’re similar in that respect, I think you should google “Hemicrania Continua”. This type of headache appears to be a migraine or cluster headache, but does not respond to triptans. Thankfully there IS a med that works and “cures” the pain the patients have been enduring for years. There are specific symptoms and details thatwill help you decide if this could be your diagnosis. I am so happy I’ve found it because I’ve been in and out of excruciating pain for 3 years with no relief! Good luck to you!

  • Laura Apr 26, 2010

    I’m currently fighting rebound headaches (again) after having to use Relpax 12-14 times last month and again this month. I always took a triptan first when I felt a migraine coming (I’ve been getting them regularly for 13 years now) – first Imitrex shots, then tablets, then Maxalt, then Treximet, and now Relpax. They stop the headache. The pattern I now see is that I use each of these drugs for 9-10 months, 4-6 times per month to begin with, and then the incidence of the headaches increases, I need more and more of the drug to stop the headache, until I end up in rebound-land where I am now, with 12-15 migraines a month and pain nearly everyday even when I don’t take anything. I change the triptan and the cycle starts over again. Currently, I am trying to cold-turkey the triptans (haven’t had one in almost a week, and although I’ve had headaches every day, but they haven’t yet developed into a full-blown migraine) and following a strict diet – no MSG, no food additives, no alcohol, etc., sleeping, eating and excersicing regularly – to see if that helps. I’m also taking fish oil, CoQ-10 and magnesium. I’m going to try acupuncture, too. My doctor is sympathetic, but hasn’t had much experience with migraine and tells me not to worry about taking too much triptan, but I’m really starting to think that’s part of my problem! I’m currently an ex-pat living outside the US where I can’t find any headache specialists. Has anyone else had a similar experience with triptans? How long do you think it should take to break the rebound headache cycle? I’m also wondering how many triptans I can take each month before setting off this cycle. I’d appreciate any insight!

    • CB May 30, 2012

      My neurologist said it takes 2 weeks for the triptans to leave your system.

  • john Apr 30, 2010

    What your not understanding is that many people with Migraine also have other pain–especially neck pain–real neck pain–not related to the migraine but that certainly can trigger a migraine. If you were to reach for a triptin first you would be taking 20 a month

    • Mike Mar 21, 2012

      That is a very good point. I have occasional neck pain and I am working with a chiropractor that feels it contributes to the eventual migraine I can get. So he feels they actually are somewhat related – at least with me, or not, its still a work in progress. If the pain is in my neck I just take Ibprofin, then work up to Maxalt when it moves forward and out of control. I worry about how many drugs go into my system – it concerns me.

  • karina de graeve Apr 30, 2010

    Laura,

    I have exactly the same experience as you have. I have been taking triptans for 10 years and have noticed that over the years the frequency (one every week)and duration of the attacks have increased. I am now convinced that this is due to taking triptans and have stopped using them altogether. Not an easy choice as it is very hard to sit out a migraine attack…. as you know probably. BUT I prefer one day of misery to an attack that lasts 3 to 5 days…My neurologist does not agree… Regards, Karina

  • Laura Apr 30, 2010

    Thanks, Karina. It’s good to know I’m not imagining the triptan repsonse. How long have you been off the triptans? What do you do to minimize your pain?

    Laura

  • Amanda Thomas Apr 30, 2010

    It’s funny that I find this thread. My study neurologist @ Clev. Clinic asked my this question as well. I participated in the SumaDose Pro study. He stated he simply didn’t understand why patients didn’t use the triptans @ the first sign of migraines when they had already paid for them, and had them available for use. Honestly, I do the same thing. I “work my way up” to the triptan. Almost like I have to justify how bad the migraine is before I use such an expensive medication.

  • Riitta May 1, 2010

    I’ve been suffering from migraines since I was 19 (now 45 yrs). I suffer monthly for about two weeks from either migraines or “migrainish” pains. I only use triptans when I feel certain that the pain is a “real” migrain, ie. the pain is centered in one particular location or other symptoms indicate this. I always take the triptan first and only after the pain has eased down I take other painkillers if needed. However, as Karina states above, also I have come to see that although triptan eases the pain, the pain comes back and the migraine easily lingers on for 4-5 days. Which is unsufferable but so far I have not found any other efficient medication. So far I have been given a painkiller injection at the hospital only once, that helped immediately. But that is not any option really.

  • karina de graeve May 2, 2010

    Hi Laura. I have stopped taking triptans 3 and a half months ago.
    Initially I used Petadolex ( capsules of the plant Petasites hybridus or Butterbur root), it is very helpful when you try kicking of medication , but it gave me minor stomach upset. If you decide to buy it make sure it is made by Weber and Weber Int. (Has anybody else out there any experience with this ?)
    I also rub on very little menthol medicated oil on the sore side or use an ice-pack. Against nausea I use ginger.
    Sometimes I resort to one tablet of Apranax 550 (Natrii naproxenum), but basically I “sit it out”. It is very hard as I cannot do anything that day and it feels like a totally lost day. The attack usually begins around 5 am and lasts until 5 pm or 6 pm. But if I take a triptan – although the pain is over in an hour and I have a “normal” day – it will come back the next day and the next and sometimes again the next… very frightening.
    I hope that this way I will be able to put more space in between the attacks and reduce their intensity…! Let me know what you do. Thanks.

  • Laura May 3, 2010

    A couple of sleepless nights led to my taking a Relpax yesterday to prevent a full-blown migraine. It had been 10 days since my last triptan “fix”, so I decided to chance it! I’ve got pain again today, but I think I’ve doged the migraine bullet this time. I can’t take the butterbur or feverfew due to other stomach issues I have – so far, the fish oil (1200mg 3x a day), Co-enzymeQ10 (100mg or 120 3x a day) and magnesium (400mg a day – more really upset my stomach) seems to be helping. Also avoiding any MSG and other food additives. I’m also 3 weeks into taking 40mg propranolol 2x a day as a preventative, but it’s too soon to tell about that. I’m hoping to be able to cut the triptans to 4x a month. I agree that using the triptan seems to extend the length of the warning pain – hopefully one good night of sleep will knock it out – that seems to work for me. I wonder if there will be any additional studies on these kinds of anecdotal issues on triptan. Maybe that new they are testing now will pan out – thanks everyone for posting your experiences – it’s great to hear all your stories!

    • Fadia Sep 10, 2012

      As an aside, what side effects have you noticed from Propranolol, Laura. I have been on a dose of 160 mgs a day (in installments) for 5 weeks. A lesser dose did not work but this reduced any headaches to twice or even once a week. However, among other things, I have gotten very depressed as a result of being on Propranolol. I am sad and lethargic but it is so hard to go back to headaches!

  • Laura May 7, 2010

    I used to use imitrex but ended up with an Rx for midrin a few years ago. I loved it! It worked really well for me and now it can’t be found. I even called the manufacturer & they said they don’t make it any more. Sad day for me! Epidrine is just not the same or work as well. I, too, avoid triptans first. I guess I am scared of any long term effects of using a vasoconstrictor over & over. I don’t see how it could be ok. I’m not a doctor but it would be nice to know what potential damage could happen to the blood vessels… Even the tiny ones.

    • Deb Sep 6, 2010

      Hi there Laura 🙂
      As far as a long term effect of triptans I’m thinking Raynaud’s could be one. Losing circulation in the extremities from just even touching something cold sends mine off. Used to have 1 finger that would do it and remember my mother having something like that. Now after some years of taking triptans it’s all fingers and toes!!

  • Philip May 14, 2010

    I’m currently in the middle of daily migraines since last october.I take Relpax with 2 Ibuprofen at the first sign of one coming on and another one 2 hours later if there is no relief.This works approx 1/2 the time.

  • Karin Sep 3, 2010

    Have read all the recent posts on triptans and re-bound etc. I have had migraines since I was 13. I am now 53. I have been taking zomig (triptan) for the past 3 years. Have seen neurologists, acupuncturists. Have been on beta blockers, topiramax (epilepsy drug), amitryptiline etc etc and preventative. Now do yoga and walk. Do not eat chocolate. Do not drink. Have average amount of stress in life. Take at least 10 zomig a month. Always seem to work but headache normally returns next day. So fed up with this debilitating disorder. Anyone have any suggestions?

  • watergirl May 14, 2011

    I am 50 yrs old and have had migraines since I was about 4 yrs old. I was also treated for ulcerative colitis for over 10 yrs. I took 15 meds a day for the UC. I found a nurse practitioner that helped me as I also took 4 pills a day preventative for the migraines along with about 3 triptans per week, I wanted to get rid of meds. After an elimination diet and allergy testing, I found out I am gluten sensitive, as well as egg,peanut and soy sensitive. These along with nutrasweet and MSG all trigger migraines in me. As for the chocolate connection, there is soy lecithin in chocolate(as well as a million other things. So it took years, but now that I found this and watch my diet, I am off of ALL of the UC meds and rarely take a triptan. I have cut back on the preventative migraine meds ( doing that slowly). So sometimes you have to look deeper. Like it may not be chocolate, it may be soy. Which means other foods trigger you as well.

  • Cheryl Aug 18, 2011

    I take Relpax (eletriptan) almost daily, probably 25 days out of the month. I can’t live without it though because when I have my migraines that is the only medicine that works! I’ve tried so many Dr’s and so many other drugs that nothing else helps. I’ve been going through this for 5-6 years now. I do feel that they are probably rebounding but every time I try to get off them or my Dr tries a different medicine, they never work! I’m at the point in life that if I want a normal life I take Relpax. If I don’t want to take medicines, I’m in bed, nauseous/vomiting, crying, on an ice pack and in extreme terrible misery. Pfizer only has tested 3 per month and I obviously surpass that by far, so I don’t know the long term effects but have no choice. Anyone else take Relpax daily?

  • Mary Beth Aug 19, 2011

    I just want to throw this out in case it may help someone. I am 50 yrs old and have had severe migraines since I was 5 yrs old. I have tried EVERYTHING. Some things with some success. Triptans being the best and yes, at times in my life I have used more than the monthly recommended dose. But about 3 yrs. ago I went to a nurse practitioner to get help for ulcerative colitis (which I thought was an incorrect diagnosis). She agreed, and I am now off of ALL of those meds. I did an elimination diet and found that I am gluten sensitive (not celiac), also very sensitive/allergic to soy, eggs and nuts. These are in a ton of things if you don’t prepare your own food and read labels. Since doing this, my migraines are under control. Hormonal ones mostly (unless I eat something I shouldn’t). I was also getting allergy shots for 10 yrs and had been tested for these foods. I showed a high reaction in all of them. But the allergist said they can’t treat food allergies/sensitivities. He never mentioned I was sensitive enough that I might try avoiding to see what happened. I’m just saying, try things that are not the typical migraine food triggers. You may have another sensitivity that you don’t know about. And it may be something that is in many things.

  • Kelly Jan 4, 2012

    I have been having migraines now for about 12 yrs and take zomig. Over the yrs the frequency has increased to the point where I am currently taking zomig 2 and 3 x’s a day. (I can qtr the pill so it’s really only about 1.3 mgs). My neurologist has prescribed steroids for a 10 day period thinking I was having rebound headaches to no avail. The headaches ceased for the full 10 days (amazing drug). However, immediately returned. Have also tried lots of different supplements, prophylactics, prolotherapy. My next thought is to try taking a break from the zomig w/o steroids. My question to anyone who has tried this since it will be terribly excruciating is how long do I have to go w/o zomig to find out if it is rebound?

  • Mike Mar 21, 2012

    Why is it that doctors never seem to get migraines? If they got to experience these, that would really help.

  • Kelly Mar 22, 2012

    I just wanted to post a status update in hopes that it might help someone else. I did take a break from the zomig (triptan) to find I was extremely addicted so my headaches have decreased tremendously. I also attribute this to a new supplement I’ve been taking called Migraine Support Formula. Hormone replacement therapy and prolotherapy. Still suffer from about 8 migraines a month but this a major improvement fo me. I’ve found I can become addicted to the triptan med after only a few days use in a row.

    • Patti MacNeil Sep 1, 2012

      Hi Kelly,
      I am about to order Migraine Support Formula for the first time. Have you found it helpful all these months later?

      Thanks,
      Patti

    • Kelly Sep 6, 2012

      Hi Patti ~ I am still taking it and highly recommend it! Please let me know how you like it. Haven’t spoken w/ anyone else yet about their results.
      Thanks,
      Kelly

      • Patti Sep 6, 2012

        Hi Kelly, thanks for the mail.
        That seals it then, I am going to order some. How long were you taking the stuff before you noticed a change? I am curious as to how much I should rider the first time.

        I met man at my doc’s office, we were both there for a second round of botox, neither of us had results from the first round. He told me he had ordered the migraine support pills. We stayed in touch and I recently heard from heard from him…he is 65, been a migraineur since he was 14 and for the first time in his life has gone over two weeks without a headache. I am not sure – maybe it’s the botox, maybe the pills, maybe a combination but I leave no stone unturned. So, I will order it and give it a go. Let you know.

        Cheers
        P

        • Kelly Sep 11, 2012

          Patti, I started taking it at the same time that I quit taking zomig (triptan) which i was extremely addicted to as i mentioned before so it took a while to recover from that but not long maybe a week before i was MUCH better. i guess im in the same boat as you though b/c i had had 4 prodedures of prolotherapy done as well as hormone replacement therapy w/ no improvement which i attribute to being addicted to triptans. So can’t really pinpoint where relief is coming from 100% but i know that if i go a few days w/o taking the MSF Supplement the migraines increase. I am still having migraines but the severity and amt has definitely decreased! Still take Zomig when i have a bad one just try not to take it too many days in a row. I take the recommended dosage of MSF 3 twice/day. dont’t know if your familiar w/ niacin or B3 but it flushes the blood system somehow and causes some tingling. i have come to see it as a would-be migraine gone astray 🙂 . Let me know how it goes and I hope and pray you get some relief soon!

          • Patti Sep 24, 2012

            HI Kelly, thanks for the details. I am waiting for the MSF and we’ll see what comes of it all. I’m prisoner in an awful zomig induced migraine rebound prison. I haven’t got the time (kids and work) for a week of pain and puking to go without meds.
            I was going to ask my doc about Flurazine as a daily preventative…ever try that one Kelly?

            Have a headache-free day my friend.
            P

          • Kelly Sep 25, 2012

            Ugh!! I didn’t know you were taking zomig and can’t get off of it. I’m telling you as one migraine sufferer to another you won’t find relief in aanything till you can get off of it. Don’t know about the flurazine, give it a try but when you do get off really it only takes about 3 days to get relief. I found that the h,aches were less intense too b/c of all the remedies (HRT MSF and prolo) they just hadn’t had a chance to work. I took tylenol PM and just tried to sleep through it. there was no puking or steel rod going through my head this time just a constant pain for about 2-3 days. Then a dull pain for 2-3 more days. Did have help from my husband. Let me know how it’s going.

          • Patti Sep 25, 2012

            Hi again Kelly, OK you have given me the incentive to get off the lousy not-so-merry go round. I will wait till MSF gets here, get a few weeks of the stuff under my belt then hunker down. My husband is great, he will manage things while I teeter on the edge of insanity. thanks for the info and for the encouragement.
            P

          • Kelly Sep 25, 2012

            Patti, So Glad to hear it. Sounds like a great plan! Let me know how you’re doing as I’ll be thinking about your suffering 🙁
            Kelly

          • Patti Sep 30, 2012

            Kelly, I can’t seem to work this site properly and I have a hard time responding to your mails properly (let alone finding them!) can we communicate directly? I am at [email protected].

            cheers
            patti

  • Mason Mar 31, 2012

    Hi there, I’m Mason from Vancouver. I had my first migraine at age 20, and it lasted about a month straight. T3s didn’t work, nor ibuprofen. I just received my second migraine ever, and this one is over a month already. I was given trial Relpax 10mg, told to take half at first sign, than another half maybe 4 hours after. I haven’t had any relief yet, I’m only on day 2 of taking it though. My main refill is maxalt 10mg though. How long did it take for others to have relief? Is it bad it isn’t working right away? The only way for me to describe my migraine is.. It’s all on the back left or right of my head, and the pain is there sun up to sun down. I’m usually bed ridden, emotionally stressed and an ice pack junkie. I just want to live a normal life again.. Any input is greatly appreiciated!

    • Laura K. Apr 1, 2012

      Hi Mason –

      My Relpax dose is a 40 mg tablet! As a rule with triptans, I have only found relief with the full dose – often the docs want to start you on a lower one, but if you read the drug insert data, you’ll see that most people find relief on the max dose. It may work for you if you take the bigger dose. Check with your doc, but 10 mg sounds like too little to be effective. You’ll have to experiment and see which triptan works for you with the fewest side effects – my daughter is still searching for the right one for her. Be careful mixing them- you should give yourself 48-72 hours between different types of triptans because of side effects. It often takes that long for them to be completely eliminated. Good luck, and just badger your doc to help you find relief!

    • Mike Apr 2, 2012

      Hello Mason:
      I know your frustration, try not to get discouraged there will be a solution.
      From my experience, when I have a migraine / bad headache, I take Maxalt 10 mg (the one that dissolves). For me it can work as fast as 20 min but sometimes it can take almost two hours. If my headache still continues after two hours I was told to take another – but no more for 24 hours, so far I have only required one dose per headache.

  • Carol Hatcher Apr 1, 2012

    Hi Mason,

    Your Relpax will only abort a migraine in its early stages. After a few hours it is not going to work. Did your doctor give you anything for when the abortive (Relpax) doesn’t work? If not, CALL YOUR DOCTOR AND ASK FOR SOMETHING. On occasion, the doctor has given my daughter a shot of pain killer which did the trick within 20 minutes in the office. It was such a relief for my daughter, I could have cried.
    DO NOT suffer a migraine for days on end. Get relief, DEMAND relief. You are worth it.

    Kind regards,
    Carol Hatcher
    Mom to Terry who had migraines for months on end until we took control

  • Kelly Apr 2, 2012

    Hi Mason:
    I know your pain brother! I’m assuming you’ve had an MRI, right? Other than that, I did not find any relief untill I sought out a doctor who was more concerned with the root of the headaches instead of putting a bandaid on them. I just found I was addicted to the prescriptions and needed more and more of them. Not to say I dont have them anymore but they have decreased greatly. I still have to rely on prescriptions at times but have learned that I cannot take them for more than 2 or 3 days in a row. This physician did a blood test, hormone test and something called Prolotherapy. I have had prolotherapy 4 times now and am getting better every time. Look it up, sounds like some of your pain may be coming from your neck. Hope and pray you get better soon!

  • Jessica W May 23, 2012

    I have had migraines Sonce college, about 6 years now. I would get about one a month and imitrex did the trick just fine. I am now getting migraines about 20 times or more a month, and almost always friday-Sunday I am in bed with them. I have tried beta blockers and topamax as preventatives.. I have not noticed either to help any. But until reading this blog I never realized you could have headaches FROM the triptans…. I feel like they are my life line… And yet maybe this is why my migraines are so frequent. My doctor never talked to me about rebound headaches or how often is too often to take them. I am so tired of this debilitating lifestyle. Suggestions? Just don’t take one with my next few migraines to give myself a break?

    • Michael May 25, 2012

      Watch for rebound headachs. I have been having some success with a chiropractor and osteopathy. Try everything!

    • Laura K May 31, 2012

      Jessica W –
      Sure sounds like you’re in rebound-land to me! First thing I’d do is get another doctor – I’ve seen a lot of sympathetic docs that just aren’t up on the latest research and try treating you with methods that are years out of date. Or they just don’t see it as something to treat aggresively- yes, the migraines won’t kill us, but they tremendously affect our quality of life. You just have to get mad and demand a good doctor and good treatment! I’ve had rebound problems myself and don’t know any way to solve it but go cold turkey for at least a couple of weeks and just suffer. You can try taking aspirin or ibuprofen or something to help, but that’s it. Using those too much can cause rebound also. I wish I had an answer. I just started acupunture a month ago and I’m off to the National Migraine Center in London tomorrow to see what they say – I’ll post an update when I return! Maybe they’ll have some good advice we can all use – Good luck!

    • Caroline Sep 8, 2012

      I totally agree with Laura – I had this kind of thing, and eventually went cold turkey on the triptans. suffered 2 or 3 full-blown vomitting 8-9 hour migraine attacks, and it settled down. Now down to taking triptans 1-2 times a month normally. The rest can be managed with migraleve or similar (which never would have touched them before). My doc had NO idea this could happen either. Good luck!

  • Cyndi May 29, 2012

    I have had migraine headaches for 28 yrs and I have been having daily migraines for the last 6 yrs. I have tried every medication whether it was preventive, abortive, whatever and have had limited relief. I have found some success with diet, chiropractic, acupuncture, oxygen therapy and homeopathic remedies. The biggest relief for me has been botox injections in my neck, temples and forehead. I would never have considered it had I not been completely desperate but it definitely helps with the neck pain and when I do get a migraine I can take my triptan medication and it works the first time and it doesn’t come back.

  • Nancy May 30, 2012

    I too, used to try to save my triptans by taking other (OTC) meds when I started to get a headache. It took me a couple of years to realize that the other medications do not work & my headaches always get worse until I take the triptans. On the advice of my neurologist, I now take one Aleve along with the triptan, at the first sign of a headache. Doing this, I can’t remember the last time I have had to take a 2nd dose of triptan. I actually use fewer triptans a month than I used to, which is good as I only get 9 a month prescribed by my doctor and paid for by insurance.

  • Liz May 30, 2012

    I live in the UK and the GP is stingy with prescriping Triptans. So, if I try and hope for the best and take a NSAID at the onset of a migraine, hoping it won’t be a horror, I have found out that I am wasting my time. Triptans are the only drug that work on a migraine, thak God they have been invented. All the hours/days wasted with pain, fiddling around with the wrong drugs!!

  • Peter H. Smith Jul 20, 2012

    This got some play in a Cluster Headache support forum: https://www.facebook.com/groups/CHSupport/ and my conclusion was the study is relevant only for migraine. The study would have mentioned O2 if it was also covering CH. I would be interested in seeing a comparison study with CH and I would expect findings that:

    1. Rebound is a serious problem with CH.
    2. Use as a secondary to O2 in conjunction with O2 would be indicated.

  • Caroline Sep 8, 2012

    Interesting reading. For a while I took this approach, using imigran (imitrex in US?) tablets. Worked brilliantly, but I ended up getting 6-10 migraines a month, way up on my previous number. Dropped back to only taking it when nothing else worked and I was really sick, and the number of migraines also dropped back gradually. It seemed the Imigran was causing a rebound cycle.
    My migraines are almost totally hormone-related, and getting them for 3 days and having to take only 1-2 triptans a month is far better for me than taking them for 10 days.
    It was only after reading online guidelines from the USA that I realised they should be limited. here in the UK they don’t have that warning about limiting the number per week.

  • Carol Oct 4, 2012

    My nearly 16 year old daughter has had migraines since she was 9 years old. Doctors have tried Midrin, Maxalt, Imitrex, Relpax, Methylprednisolone, lots of various pain medications and pain injections. She seen Doctors who told us it was all in her head and referred us to a therapist (this was when she was 9 years old with her first migraine ever and the CAT scan showed no sinus problem). She has had doctors that told us it’s due to her period going to start (which didn’t for 3 years). The past 2 years, she had been taking 3 Ibuprofen at on-set; wait 30 minutes, then 40 mg. Relpax and if still intense migraine 1 hour later, take 20 mg. more of Relpax. She takes Zofran that really helps her nausea from the Relpax and migraines. This regime is rotated with Imitrex, same regime as with Relpax. Sometimes effective, sometimes not at all. She has a new doctor who told us that since her migraines start at the top of her forehead (the pain stays there and continues to spread to the top and then back of her head), that they are not true migraines, but stress/tension headaches, and this is why the migraine medications are not very effective? I’d think a stress headache would resolve with lortab, percocet or tordal? So….she recently started Amitriptyline and currently has a migraine for past 2 days. This has been interesting and helpful hearing from other migraine sufferers. We had no idea that the Relpax can cause rebound migraines. I would be interested in any comments from other migraine sufferers.

  • Patti Oct 5, 2012

    Hi Carol, A friend’s daughter is 14, has awful headaches, was never prescribed anything stronger than advil an by the family doc. She took her daughter instead to the headache clinic at the local children’s hospital where the pediatric neuro and they prescribed Flunarizine. She has been on it two weeks and not had one headache. Having read about a bit and spoken to my doc about for me she said it doesn’t work that fast but has shown good results for some. So, is it the drug or is it because someone finally helped her and it relaxed her, created a placebo effect perhaps…? who knows but she is pain free so far. You might want to ask about it. I feel for you. I would gladly hang onto these headaches for the rest of my life and stop seeking relief if I knew it would guarantee that my kids would never get one. Good luck, patti

  • Milan Felt Oct 8, 2012

    My problem is getting a Triptan medicatiion for a child age 4 suffering from migraine headaches. My insurance company refuses to sanction any Triptan medication unless you are 18 or over. Is there anyway to get the insurance company to sanction Imitrex or some other Triptan or do I end up paying for the drug myself.

  • maureen Nov 21, 2012

    I need to go cold turkey on my Relpax. I’ve absolutely needed them to get through my work day, etc. for several years and know I am addicted. Prior to that it was other Triptans. Any suggestions on diet while I go through cold turkey? Tks.

  • Patti Nov 23, 2012

    My migraines are gone. i am not being paid to say that – by anyone!
    I have suffered migraines for most of my adult life, I am now 51.

    In that time I have tried everything from ice packs to preventive meds to meditation to botox. I have given up foods and vices and paid for contraptions to wear in my mouth, around my wrist or on my head. I bought a bedspread full of magnets that I was told would cure me, it did not. It was expensive and cost a fortune to dry clean.

    I have been for massage, chiropractic adjustments, reflexology and acupuncture. I have also paid exorbitant amounts of money to people who practice all manner of crazy off-the-grid stuff all of who claimed they could cure me, none of whom did and one of whom told me my headaches were a result of being beheaded in a former life. That was such a BIG help.

    If I had all the money that I spent traveling down all these pharmaceutical and therapeutic and voodoo paths I could buy a replacement head.

    I have taken enough over-the-counter pain pills in my lifetime to kill a herd of elephants. I have had great success with Zomig but in recent years found myself in a crippling rebound cycle of meds and headaches brought on by meds. I worry about my liver, my heart and the Zomig is a nasal spray so the inside of my nose feels I have been snorting glass.

    The compounding feelings of fatigue, desperation, depression, irritability and immeasurable pain have been consuming. Every vacation and special event is anticipated with dread rather than joy. If I run out of meds I am practically catatonic with fear.

    It has affected my work, my personal life and, much to my dismay, my parenting.

    When I read about Migraine Support Formula I didn’t give it much thought. I had tried feverfew and vitamin B before and it didn’t work. The notion that the beast who lived inside my head could be quieted with natural products was ludicrous. A morphine drip, that’s what I was looking for.

    I read the comments people wrote purporting miraculous health and was sure every one of them was fabricated and this was nothing more than snake oil online.

    But, pain makes people do crazy things, so I ordered the stuff and it works!

    I will take a lie detector test – my experience is real.

    The day it arrived I started taking it and changed nothing else.
    I took three in the morning, three at night.
    During those first seven days I had four migraines which I treated with Zomig. Standard week.
    The second week I had only two migraines and one felt less “mean” so I took two Advil for migraine and it went it away fast. That has NEVER worked before. Advil and Tylenol made the same impact Smarties would.
    Week three – NO migraines. Holy smokes!
    I am closing in on the end of the first month of using the formula and in the last 14 days I felt the beginnings of one migraine that I stopped cold with an a couple of Advil and a coffee.

    I cannot begin to articulate how wonderful it is to be clear headed, focused, productive, happy, and hopeful. Normal. Only it’s better than normal because it is such a huge transformation from what was.

    Please please please believe me and try this stuff and I sincerely, with every fibre of my being, hope you have the same results.

    • Kelly Nov 26, 2012

      I am soooo happy for you Patti! Hopefully others will try this product and get relief as well.

      • Patti Dec 3, 2012

        Thnaks Kelly.

        And how are you?
        Any changes? Relief?
        P

        • Kelly Dec 4, 2012

          I’m doing great as far as migraines. Really don’t get them until menstrual cycle anymore. Especially if I stay away from chocolate and red wine. 🙁 The seasonal change seems to help as well. Can’t handle the heat too well. Given where I came from (migraine wise) I couldn’t be happier. Literally, my life has changed and I’m so happy yours has too!

  • ted saldana Jun 21, 2013

    I am a 55 yr old male, I’ve been having headaches for over 30 years, I have cluster migraines, triptans are the only thing that work on me, imitrex, Relpax, and imitrex injections, the injections work the best for me, normally takes about 10 minutes,my migraines wake me up out of my sleep normally around 3 a.m. I hate it, normally last a couple of months to a year. .then they go away for maybe 2 years, until I have that feeling and I start to panic because I don’t have any meds on me..I don’t wish it on my worst enemy, I just want to know Dr sometimes I’ll take a relpax when I feel one coming on, but if my eye. start to swell and starts to water I’ll do a shot of imitrex because the pain is so great.is that okay .because they’re two different drugs or is that a bad thing all I know is that it works in about 10 minutes instead of an hour.please advise

  • Janet Jones Aug 7, 2013

    How can anyone in their right mind take a triptan very time for a MOGRAINE attack. I’m a chronic migraine sufferer, which means I have a migraine daily. I’d have a stroke or heart attack if I took a triptan everyday.

    I was hospitalized in 2004 for imitrex overuse…I was taking 3 a day for 10 months!!!!!!

    In today’s life I need frova every copy of days….but I only get 9 a month now and am trying to configure how to salvage them…I have plenty of triptans in my stash….relpax…zomig…maxalt…treximet…but we all know if you mix these..you’ll die….I’d like a doctor to tell me a triptan at each onset of a migraine…I mean no disrespect….but that recommendation or direction on taking triptans is insane.

    Janet Jones

  • Gail Aug 23, 2013

    Hi, has anyone other than me noticed that the new generic for Maxalt does not work for them like the brand name does? This is very distressing as I put in an appeal to my insurance as they will not cover the brand name, and they denied my appeal! Now I’m stuck as the Maxalt was the only Triptan to work for me!

    • Janet Jones Aug 23, 2013

      Yes Gail…I found that to be true for me. I was excited at first because the co-pay was affordable…but at the cost of it not working as well and I find I suffer from itching and a bit of throat swelling…I’m taking frova now…no generic yet. I haven’t appealed o insurance yet…they have allowed me to get brand name in the past but at quite a cost….migraines are not considered disabling like other diseases by the government …so we suffer at the hands of the FDA 🙁

      Blessings,
      Janet

      • Caroline Nov 25, 2013

        Hi Gail

        Yes, I also found this and my doctor has to specify imigran-only (no generic versions) on the prescription.

        Very odd as the drug must be the same to be licenced!

  • Joyce Nov 23, 2013

    I always take my Imitrex first, but ALWAYS with ibuprofen to help mitigate the awful side effects of the Imitrex. I generally have “hangover” the next day, and can also count on the IBS. Still better than a migraine.

  • Lesley Nov 23, 2013

    I have used Imitrex since it first was approved inU.S. First as injection then in pill form. Use at first sign of head pain,vary dose age as after all the years can usually tell how severe an attack is coming..so 50 or 100mg.,get 100mg and a pill splitter to stretch,have approval for name brand only(2 generics did not work),and have on occasion had over-ride to get a refill sooner. Have Chronic migraines and have had to use Imitrex up to 11 days in a row with no rebound. In 33years have found no prophylatic that worked or could tolerate. Just my personal experience.

  • Janet Jones Nov 23, 2013

    Just curious,,.imitrex worked for me for years…but when generic came out, it stopped. Are you actually talking the brand name Imitrex or sumatriptan???

    Blessings
    Janet

  • Denise Nov 23, 2013

    I try not to HAVE to take them. My insurance only covers 4 pills a month. That can be wiped out in two days with a really bad migraine. There are signs if I am going to have a really bad one that I am learning to pay attention to: unexplained euphoria, seeing shadows that race by. When I have those right before my head starts to hurt, I know it is going to be full blown, so I will take the imatrex to avoid it.

  • Lesley Nov 23, 2013

    Janet…I use name brand Imitrex only. As for the generic,I I tried two different manufacturers and neither worked. Dr. Specifies name brand only on prescription ,meaning no generic. Costs more but works.

  • Caroline Nov 24, 2013

    Interesting study results, but I have to say that when I tried this for a while I got so many rebounds and went from 3-4 a month up to about 8 or 9 migraines a month (all seemed hormonal so 2 weeks wiped out). So I’d always try other drugs first now and avoid triptans if at all possible. Much as I love imigran (imitrex) injection, I don’t want it too often. I couldn’t go back to that.

  • Sarah Nov 25, 2013

    Its a difficult decision. I try to avoid taking straight away just in case I’ve mistaken a headache for a migraine. Last week I took one at the first sign and the migraine didn’t return the following day as it normally does if I take it too late. This weekend I was so fed up I went cold turkey and after 24 hours felt my head was going to explode so I took it late in the migraine, 8 hours later it was back again. Refused to take another triptan and just stuck it out another 24 hours. I couldn’t be without imigram but I don’t want to become immune by taking too often.

  • sally jarvis Feb 11, 2014

    I most often take Zomig as soon as I feel a migraine starting – it’s very unlikely to fade out, I know from experience. It gives total relief of pain within an hour. However, after suffering migraines for 35 years, and with them increasing in the last few years, I rarely go over 8 days migraine-free, and often only 4 days. I have my first assessment at a migraine clinic in 3 days time, so hopefully they can find something else to allow me to function at work. I am terrified of running out of Zomig, as I remember 3-4 day bi-monthly periods of hell before finding it.

  • Greg Oct 26, 2015

    I have had some luck with taking magnesium glycinate (400 mg) when I have a headache (I nearly always wake up with them), but you need to give it about an hour. I’ll also follow them with sodium naproxen if I don’t notice an improvement in an hour or so.

  • Franci Apr 6, 2016

    I take 100mg sumatriptan everyday for the daily migraine which begins between 2 am and 5 am. It works much better if I take it when I feel the first symptoms than if I wait. If I have to be at work at 7, taking the Sumatriptan at 3 and going back to sleep makes it possible to wake up without the migraine and get ready for work. Without it I cannot even get out of bed. Sad but so far, this is all that works.

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