Sumatriptan for the treatment of acute migraine
Sumatriptan is a prescription drug approved by the United States Food and Drug Administration (FDA) for the treatment of migraine headaches with or without aura in adults. It is one of the triptans, a group of prescription migraine medications used for acute migraine attacks.
Brands of sumatriptan available in the United States include:
- Imitrex (pill, nasal spray or suppository)
- Imitrex STAT dose system (injection via pen)
- Onzetra Xsail (nasal powder)
- Zembrace SymTouch (injection)
The varying routes of administration of sumatriptan provide convenient options for managing your migraine headaches. If you experience severe nausea and vomiting with your migraines, you may not want to take your medicine by mouth and you may not be able to hold it long enough to absorb it into your body. An alternate route allows your body to absorb the medicine so that it can function.
Sumatriptan injections in particular also have a faster onset of action than a pill, providing faster relief.
How it works
Vasodilation (widening of blood vessels) in the brain is associated with migraine headaches. It is not clear whether vasodilation is the physiological event that triggers migraines, or if it occurs after other changes, such as alterations in neurotransmitters or changes in electrical activity.
However, sumatriptan, like other triptans, targets serotonin (5-HT) receptors in the brain. It is believed to work by blocking pain pathways in the brain and narrowing blood vessels to provide migraine relief.
Sumatriptan is intended to be taken as needed, with some restrictions. Before taking sumatriptan, be sure to review the dose that your healthcare professional recommends. There are different recommended starting points for several of the forms, and each has a maximum recommended dose that can be taken at one time, as well as over a 24-hour period.
Oral sumatriptan is available as 25 mg, 50 mg or 100 mg tablets. If a migraine is not relieved within two hours of the first dose, a second dose may be taken.
The total daily dose should not exceed 200 mg.
With sumatriptan nasal powder, a single 22 mg dose (one 11 mg nasal tip in each nostril) is taken. As with oral sumatriptan, if the migraine does not go away within two hours (or comes back), treatment may be repeated once.
The maximum daily dose should not exceed 44 mg (four nasal pieces).
With sumatriptan nasal spray, a single dose of 5 mg, 10 mg or 20 mg is taken in one nostril, or a total dose of 10 mg can be taken as a 5 mg dose in each nostril. If the migraine persists or reappears within two hours of using the spray, a second spray may be given.
Research suggests that a 20 mg dose is more effective than 5 mg or 10 mg.
The maximum daily dose is 40 mg.
The injectable doses of sumatriptan and imitrex vary from 1 to 6 mg applied subcutaneously (under the skin). A second injection can be repeated if the first is not effective.
The maximum daily dose is 12 mg in 24 hours.
Zembrace is used at an initial dose of 3 mg and may be repeated up to three times, each injection being separated by one hour.
The maximum daily dose is 12 mg.
Remember to take sumatriptan at the start of your migraine. Taking it early can help prevent an attack from reaching its peak intensity.
The most common side effects of sumatriptan result from vasoconstriction, which can occur not only in the brain, but also throughout the body.
Common side effects include:
- Sensation of pins and needles in the fingers, hands or arms
- Feeling hot or cold, especially in the hands
Sumatriptan nasal spray or nasal powder may cause a bad taste in the mouth, as well as irritation of the nose and throat. The nasal spray may also produce a burning sensation when applied, and the nasal powder may cause a runny or stuffy nose.
With the injection of sumatriptan, some people develop irritation of the skin where the injection is given.
Serious adverse events include:
- Chest pain, tightness. pressure and / or heaviness
- Pain, tightness and / or pressure in the neck, throat or jaw
If you experience any of the serious side effects of sumatriptan, see a doctor immediately.
Sumatriptan and other triptans have been associated with cardiovascular and vasospastic events (blood vessel spasms). These types of events can lead to serious consequences, including heart attack and stroke.
A rare complication, serotonin syndrome, may occur if you take a triptan with antidepressants in the drug categories Selective Serotonin Reuptake Inhibitors (SSRIs) or Selective Serotonin Norepinephrine Reuptake Inhibitors (SNRIs).
You should be aware of the symptoms of serotonin syndrome if you are taking such a combination.
It is not safe for you to use a triptan if you have a history of heart attack, stroke, transient ischemic attack (TIA), coronary artery disease, peripheral vascular disease, ischemic disease. bowel or any type of angina (stable or Prinzmetal).
Likewise, experts suggest taking a triptan with caution if you have risk factors for coronary heart disease, such as obesity, a history of smoking or diabetes, or a family history of heart disease.
Other contraindications include:
It is important to note that sumatriptan can be used during pregnancy, but with caution. Adequate and well-controlled studies in pregnant women are lacking, and animal studies have shown that sumatriptan can potentially harm the unborn child. If you are using sumatriptan, be sure to tell your healthcare professional if you are pregnant or plan to become pregnant, as you may need to change your migraine medication.
A word from Verywell
Keep in mind that sumatriptan is generally safe and effective in treating moderate to severe migraine episodes. Knowing about the different routes of administration, side effects and contraindications can help you discuss this option with your healthcare professional.
It is generally recommended that you try over-the-counter treatments for your migraines first before switching to prescription medications. If sumatriptan works for you, keep track of how many pills you use per month. If you regularly take more than two doses per week, you should discuss migraine prevention strategies with your healthcare professional because it is easier and safer to prevent migraines than to constantly try to treat them.