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?
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.
Popularity: 15% [?]
Loading ...
{ 29 comments… read them below or add one }
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.
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.
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.
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.
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.
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.
James –
Interesting data. Has the full study been published anywhere? I’d be interested in reading….
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.
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.
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…..
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.
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.
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!
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!
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
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
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
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.
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.
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.
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!
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.
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!!
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.
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?
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.
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?
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.
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?