Triptans were developed specifically for the acute treatment of migraine. The first clinically available triptan was sumatriptan, which has been marketed since 1991. All of the triptans inhibit the release of vasoactive peptides, promote vasoconstriction, and block pain pathways in the brainstem. Triptans inhibit transmission in the trigeminal nerve, thereby blocking input to neurons; this effect is probably mediated by reducing the levels of calcitonin gene-related peptide (CGRP).
The available triptans include sumatriptan, zolmitriptan, naratriptan, rizatriptan, almotriptan, eletriptan, and frovatriptan. Sumatriptan can be given as a subcutaneous injection, as a nasal spray, as a nasal powder, or orally. Zolmitriptan is also available for both nasal and oral use. The others are available for oral use only. The choice of a triptan should be individualized; different pharmacologic properties and delivery routes may help guide the choice. Patients who do not respond well to one triptan may respond to another. Sumatriptan offers the most options for routes of drug delivery, with subcutaneous sumatriptan offering the fastest onset of action. Naratriptan and frovatriptan have the slowest onset of action among the triptans and may have the lowest propensity to cause side effects.
Triptans have proven to be safe and effective for most patients with migraine. As with all medications, there are concerns, risks, and contraindications. The risks and benefits should be discussed with a provider, and patients should be monitored.
–Alice Wong, NP