triptans

Triptans are a class of medications used to treat acute migraine attacks. They are selective agonists of the serotonin 5-HT1B and 5-HT1D receptors. Activation of these receptors leads to constriction of cranial blood vessels, inhibition of neuropeptide release from trigeminal nerve endings, and suppression of pain signaling in brainstem pathways. They are for acute treatment, not prevention, and are most effective when taken early in a migraine.

Common triptans include sumatriptan, rizatriptan, zolmitriptan, eletriptan, almotriptan, naratriptan, and frovatriptan. They differ in onset, duration, and tolerability: several provide rapid relief within an hour, while naratriptan and frovatriptan have longer durations and slower onset. They are usually taken as a single dose at onset of migraine, with a second dose permitted if symptoms recur after a specified interval (varies by agent).

Contraindications include known cardiovascular disease (ischemic heart disease, stroke, TIA, coronary vasospasm), uncontrolled hypertension, and other conditions where vasoconstriction could be harmful. They should not be used with ergot alkaloids or within a window of those medications. Caution is advised when used with other serotonergic agents (for example some antidepressants) because of the risk of serotonin syndrome. Common side effects include numbness or tingling, warmth, dizziness, chest pressure, and nausea; rare but serious risks include coronary vasospasm and arrhythmia.

Medication-overuse headache can occur if triptans are used too frequently. Triptans are generally prescribed for adults and some are approved for use in children.