Triptans: Treatment of Migraine and Cluster Headaches

Triptans: Treatment of Migraine and Cluster Headaches
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Migraines are severe, debilitating headaches often accompanied by nausea, vomiting, and sensitivity to light, sound, and motion. Cluster headaches are headaches that are so severe they are sometimes called “suicide headaches.” In the past, sufferers of both these conditions have had to endure the pain, often aided only by general pain relievers such as aspirin, acetominophen (paracetamol), and non-steroidal anti-inflammatory drugs (NSAIDs).

What Are Triptans?

In 1993, sumatriptan, the first of a new class of drugs known as the triptans, became available for treating migraine headaches. Triptans have also been shown to be effective for cluster headaches. Triptans are used after onset of an attack.

The triptan class of medications includes the following drugs (generic names given, followed by brand names in parentheses):

  • almotriptan (Axert, Almogran)
  • eletriptan (Relpax)
  • frovatriptan (Frova, Migard)
  • naratriptan (Amerge, Naramig)
  • rizatriptan (Maxalt)
  • sumatriptan (Imitrex, Imigran)
  • zolmitriptan (Zomig)

How Triptans Work

Triptans are 5-HT receptor agonists. The 5-HT receptor is one of the receptors for the neurotransmitter serotonin receptor in the cells of the brain. Triptans act like serotonin on these receptors. Their clinical effects include vasoconstriction.

How quickly triptans act depends on what type of headache they are taken for and how they are administered. When a triptan drug is taken orally for a migraine headache, significant (but usually not complete) pain relief is felt within two hours. When injected for cluster headaches (usually sumatriptan), relief can come within 15 minutes. If inhaled nasally for cluster headaches, triptan drugs become effective within half an hour (Consumer Reports, New York Times).

Disadvantages of Triptans

Triptans are expensive drugs. In the United States, none are currently available as generics, and they typically cost $21-26 per oral dose and more for injectable or nasal spray forms (Consumer Reports). Since these medications are used episodically, the cost of triptan treatment varies with the frequency with which they are needed.

Triptans can be dangerous for patients with various problems related to the heart and circulatory system, such as coronary artery disease, history of heart attack, peripheral vascular disease, high blood pressure, and angina, as well as for people with diabetes and severe obesity.

Because they operate on serotonin receptors, triptans are associated with serotonin syndrome when taken in conjunction with certain antidepressants. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) both increase the availability of serotonin in the brain. The combination of these medications with triptans, which mimic serotonin, have been reported in some cases to result in respiratory failure, coma, mania, hallucinations, and other symptoms of serotonin syndrome (FDA 2006).

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