The use of triptans as an effective form of migraine treatment – review
DOI:
https://doi.org/10.12775/QS.2025.37.56600Keywords
migraine, triptans, almotriptan, sumatriptanAbstract
Introduction Migraine, a prevalent neurological disorder, is characterized by recurrent episodes
of moderate to severe headache, often accompanied by symptoms such as nausea, photophobia, and phonophobia. Triptans, which belong to the class of serotonin 5-HT1B/1D receptor agonists, are integral to the management of migraine, providing prompt relief from symptoms.
Aim of the study To clarify how effective triptans are in treating migraines, highlighting their role in symptom relief and improving patients' quality of life
Materials and methods The article is the result of a comprehensive analysis of present-day scientific literature, which has been collected from PubMed, Scopus, and Google Scholar. The literature was systematically reviewed utilizing specific keywords.
Results Studies consistently show high efficacy of triptans in treating acute migraines. These pharmaceuticals markedly alleviate pain and symptoms like nausea, photophobia, and phonophobia, providing substantial pain relief. Differences in triptan medications' onset and half-life affect their therapeutic duration and headache recurrence rate. The pharmacokinetic properties of each triptan significantly affect its efficacy and headache recurrence likelihood. Frovatriptan, with its long half-life, showed superior efficacy in reducing migraine recurrence. Conversely, rizatriptan, with its rapid action, offered quick pain relief. In clinical trials, all triptans showed favorable tolerability profiles. Reported adverse effects were generally mild.
Conclusions Triptans are effective and safe for managing acute migraines. The diverse formulations and swift onset make these treatments essential for migraine management. Choose a triptan based on efficacy, safety, and patient preferences. More research is needed to improve triptan treatments for migraine, focusing on reducing headache recurrence and enhancing patient tolerability.
References
Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiol Rev. 2017;97(2):553-622. doi:10.1152/physrev.00034.2015.
Steiner TJ, Stovner LJ, Jensen R, Uluduz D, Katsarava Z. Migraine remains second among the world's causes of disability, and first among young women: findings from GBD2019. J Headache Pain. 2020;21:137. doi:10.1186/s10194-020-01138-6.
Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68(5):343-349. doi:10.1212/01.wnl.0000252809.43131.54.
Tfelt-Hansen P, De Vries P, Saxena PR. Triptans in migraine: A comparative review of pharmacology, pharmacokinetics and efficacy. Drugs. 2000;60(6):1259-1287. doi:10.2165/00003495-200060060-00005.
Ferrari MD, Roon KI, Lipton RB, Goadsby PJ. Oral triptans (serotonin 5-HT(1B/1D) agonists) in acute migraine treatment: A meta-analysis of 53 trials. Lancet. 2001;358(9294):1668-1675. doi:10.1016/S0140-6736(01)06711-3.
Aguilar-Shea A, Membrilla J, Diaz-de-Teran J. Migraine review for general practice. Aten Primaria. 2021. doi:10.1016/j.aprim.2021.102208.
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia. 2018;38(1):1-211. doi:10.1177/0333102417738202.
World Health Organization. Factsheet No. 277: Headache Disorders. Available from: http://www.who.int/mediacentre/factsheets/fs277/en/. October 2012.
Vgontzas A, Renthal W. Migraine-associated gene expression in cell types of the central and peripheral nervous system. Cephalalgia. 2020;40(5):517-523. doi:10.1177/0333102419877834.
Ozge A, Abu-Arafeh I, Gelfand AA, Goadsby PJ, Cuvellier JC, Valeriani M, et al. Experts’ opinion about the pediatric secondary headaches diagnostic criteria of the ICHD-3 beta. J Headache Pain. 2017;18(1):113. doi:10.1186/s10194-017-0819-x.
Silberstein SD, Merriam GR. Estrogens, progestins, and headache. Neurology. 1991;41(6):786-793. doi:10.1212/wnl.41.6.786.
Neri I, Granella F, Nappi R, Manzoni GC, Facchinetti F, Genazzani AR. Characteristics of headache at menopause: a clinico-epidemiologic study. Maturitas. 1993;17(1):31-37. doi:10.1016/0378-5122(93)90121-w.
Fettes I. Migraine in the menopause. Neurology. 1999;53(4 Suppl 1). PMID:10487511.
Goadsby PJ, Edvinsson L. The trigeminovascular system in migraine: Pathophysiology and therapeutic targets. CNS Neurol Disord Drug Targets. 2006;5(1):89-99. doi:10.2174/187152706784111996.
Levy D. Migraine pain, meningeal inflammation, and mast cells. Curr Pain Headache Rep. 2009;13(3):237-240. doi:10.1007/s11916-009-0043-z.
Pietrobon D, Moskowitz MA. Pathophysiology of migraine. Annu Rev Physiol. 2013;75:365-391. doi:10.1146/annurev-physiol-030212-183717.
Edvinsson L. The trigeminovascular pathway: Role of CGRP and PACAP in migraine. Nat Rev Neurol. 2019;15(4):173-183. doi:10.1038/s41582-019-0151-y.
Dodick DW. A phase-by-phase review of migraine pathophysiology. Headache. 2018;58(Suppl 1):4-16. doi:10.1111/head.13300.
Tfelt-Hansen P, De Vries P, Saxena PR. Triptans in migraine: A comparative review of pharmacology, pharmacokinetics and efficacy. Drugs. 2000;60(6):1259-1287. doi:10.2165/00003495-200060060-00005.
Humphrey PP, Feniuk W, Perren MJ, Beresford IJ, Skingle M, Whalley ET. The pharmacology of the novel 5-HT1-like receptor agonist, sumatriptan. Eur J Pharmacol. 1990;182(1):193-210. doi:10.1016/0014-2999(90)90284-X.
Pöstges T, Lehr M. Metabolism of sumatriptan revisited. Pharmacol Res Perspect. 2023;11(1). doi:10.1002/prp2.1051.
Edvinsson L. The role of CGRP in migraine. Handb Exp Pharmacol. 2019;255:121-132. doi:10.1007/164_2018_170.
Silberstein SD, Dodick DW. Migraine Genetics: Part II. Headache. 2013;53(8):1230-1238. doi:10.1111/head.12180.
Dodick DW, Lipton RB, Martin V, Papademetriou V, Rosamond W, MaassenVanDenBrink A. Consensus statement: Cardiovascular safety profile of triptans (5-HT agonists) in the acute treatment of migraine. Headache. 2004;44(5):414-425. doi:10.1111/j.1526-4610.2004.04085.x.
Tepper SJ. CGRP and headache: A brief review. Neurol Sci. 2019;40(Suppl 1):99-105. doi:10.1007/s10072-019-03718-6.
Ferrari MD, Goadsby PJ, Roon KI, Lipton RB. Triptans (Serotonin 5-HT1B/1D Agonists) in Migraine: Detailed Results of a Meta-Analysis of 53 Trials. Cephalalgia. 2002;22(8):633-658. doi:10.1046/j.1468-2982.2002.00404.x.
Cady RK, Schreiber CP, Penzien DB. Sumatriptan: Clinical Trials, Mode of Action, Safety and Efficacy in the Acute Treatment of Migraine. Cephalalgia. 1991;11(Suppl 11):109-113.
Tepper SJ, Rapoport AM, Sheftell FD. Mechanisms of Action of the 5-HT1B/1D Receptor Agonists. Arch Neurol. 2002;59(7):1084-1088. doi:10.1001/archneur.59.7.1084.
Dodick DW, Shewale AS, Lipton RB, Baum SJ, Marcus SC, Silberstein SD, Pavlovic JM, Bennett NL, Young WB, Viswanathan HN, Doshi JA, Weintraub H. Migraine Patients With Cardiovascular Disease and Contraindications: An Analysis of Real-World Claims Data. J Prim Care Community Health. 2020;11:2150132720963680. doi:10.1177/2150132720963680.
Durham PL. Calcitonin Gene-Related Peptide (CGRP) and Migraine. Headache. 2006;46(Suppl 1). doi:10.1111/j.1526-4610.2006.00483.x.
Edvinsson L, Haanes KA, Warfvinge K, Krause DN. CGRP as the Target of New Migraine Therapies – Successful Translation from Bench to Clinic. Nat Rev Neurol. 2018;14(6):338-350. doi:10.1038/s41582-018-0003-1.
Abram JA, Patel P. Zolmitriptan. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557649/
Bird S, Derry S, Moore RA. Zolmitriptan for acute migraine attacks in adults. Cochrane Database Syst Rev. 2014;2014(5). Published 2014 May 21. doi:10.1002/14651858.CD008616.pub2.
Winner P, Farkas V, Štillová H, Woodruff B, Liss C, Lillieborg S, Raines S, TEENZ Study Group. Efficacy and tolerability of zolmitriptan nasal spray for the treatment of acute migraine in adolescents: Results of a randomized, double-blind, multi-center, parallel-group study (TEENZ). Headache. 2016;56(7):1107-1119. doi:10.1111/head.12860.
Dodick DW, Brandes JL, Elkind AH, Mathew NT, Mauskop A, DeBusk K, et al. Speed of onset and efficacy of zolmitriptan nasal spray in the acute treatment of migraine: Results from phase 3 clinical trials. CNS Drugs. 2005;19(12):1053-1064. doi:10.2165/00023210-200519120-00004.
Oskoui M, Pringsheim T, Holler-Managan Y, et al. Practice guideline update summary: Acute treatment of migraine in children and adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2019;93(11):487-499. doi:10.1212/WNL.0000000000008095.
Xu H, Han W, Wang J, Li M. Network meta-analysis of migraine disorder treatment by NSAIDs and triptans. J Headache Pain. 2016;17(1):113. doi:10.1186/s10194-016-0697-1.
Charlesworth BR, Dowson AJ, Purdy A, Becker WJ, Boes-Hansen S, Färkkilä M. Speed of onset and efficacy of zolmitriptan nasal spray in the acute treatment of migraine: a randomized, double-blind, placebo-controlled, dose-ranging study versus zolmitriptan tablet. CNS Drugs. 2003;17(9):653-667. doi:10.2165/00023210-200317090-00005.
Rapoport AM, Tepper SJ, Sheftell FD, Smith TR. Comparative efficacy of zolmitriptan 5 mg nasal spray versus sumatriptan 50 mg tablet in the acute treatment of migraine. Headache. 2003;43(3):236-244. doi:10.1046/j.1526-4610.2003.03047.x.
Jastrzębski K. Tryptany w migrenowych bólach głowy - bilans korzyści i ryzyka. Aktualn Neurol. 2017;17(2).
Dodick DW, Brandes JL, Elkind AH, Mathew NT, Sumatriptan-Naproxen Study Group. Speed of onset, efficacy and tolerability of eletriptan for the acute treatment of migraine: a multicenter, randomized, double-blind, placebo-controlled study. Cephalalgia. 2007;27(5):358-368. doi:10.1111/j.1468-2982.2007.01307.x.
Goldstein J, Stiles M, Gawel M, Pait DG, Carides AD. Eletriptan in the early treatment of acute migraine: placebo-controlled, dose-ranging study. Headache. 2001;41(10):985-991. doi:10.1046/j.1526-4610.2001.01182.x.
Capi M, Curto M, Lionetto L, de Andrés F, Gentile G, Negro A, Martelletti P. Eletriptan in the management of acute migraine: an update on the evidence for efficacy, safety, and consistent response. Ther Adv Neurol Disord. 2016;9(5):414-423. doi:10.1177/1756285616650619.
Lipton RB, Baggish JS, Stewart WF, Codispoti JR, Fu M. Efficacy and safety of eletriptan in patients with migraine: a phase III, placebo-controlled, dose-ranging study. Neurology. 2000;54(9):1715-1723.
Dodick DW, Lipton RB, Ailani J, et al. Effect of eletriptan on migraine-related functional disability: A pooled analysis of clinical trial data. Headache. 2015;55(5):681-693. doi:10.1111/head.12557.
Spierings EL, Gomez-Mancilla B, Grosz DE, Rowland CR, Whaley FS, Jirgens KJ. Oral almotriptan vs. oral sumatriptan in the abortive treatment of migraine: a double-blind, randomized, parallel-group, optimum-dose comparison. Arch Neurol. 2001;58(6):944-950. doi:10.1001/archneur.58.6.944.
Dahlöf C, Tfelt-Hansen P, Massiou H, Fazekas A., Almotriptan Study Group. Dose finding, placebo-controlled study of oral almotriptan in the acute treatment of migraine. Neurology. 2001;57(10):1811-1817. doi:10.1212/WNL.57.10.1811.
Pascual J, Vila C. Almotriptan: a review of 20 years' clinical experience. Expert Rev Neurother. 2019;19(8):759-768. doi:10.1080/14737175.2019.1591951.
Patniyot IR, Gelfand AA. Acute Treatment Therapies for Pediatric Migraine: A Qualitative Systematic Review. Headache. 2016;56(1):49-70. doi:10.1111/head.12716.
McEnroe JD, Fleishaker JC. Clinical pharmacokinetics of almotriptan, a serotonin 5-HT(1B/1D) receptor agonist for the treatment of migraine. Clin Pharmacokinet. 2005;44(3):237-246. doi:10.2165/00003088-200544030-00002.
Thorlund K, Toor K, Wu P, Chan K, Druyts E, Ramos E, Bhambri R, Donnet A, Stark R, Goadsby PJ. Comparative tolerability of treatments for acute migraine: A network meta-analysis. Cephalalgia. 2017;37(10):965-978. doi:10.1177/0333102416683910.
Dodick D. Rizatriptan: a review. Expert Opin Pharmacother. 2003;4(11):2109-2118. doi:10.1517/14656566.4.11.2109.
Lewis D, Winner P, Saper J, et al. Randomized, double-blind, placebo-controlled study of rizatriptan 5 mg and 10 mg for the acute treatment of migraine in adolescents. Headache. 2002;42(1):49-55. doi:10.1046/j.1526-4610.2002.02008.x.
Masuo Y, Nagamori S, Hasegawa A, et al. Utilization of Liver Microsomes to Estimate Hepatic Intrinsic Clearance of Monoamine Oxidase Substrate Drugs in Humans. Pharm Res. 2017;34(6):1233-1243. doi:10.1007/s11095-017-2137-0.
Tfelt-Hansen P. Naratriptan is as effective as sumatriptan for the treatment of migraine attacks when used properly. A mini-review. Cephalalgia. 2021;41(14):1499-1505. doi:10.1177/03331024211028959.
Tfelt-Hansen PC. Published and not fully published double-blind, randomised, controlled trials with oral naratriptan in the treatment of migraine: a review based on the GSK Trial Register. J Headache Pain. 2011;12(4):399-403. doi:10.1007/s10194-011-0327-3.
Moschiano F, Allais G, Grazzi L, Usai S, Benedetto C, D'Amico D, Roncolato M, Bussone G. Naratriptan in the short-term prophylaxis of pure menstrual migraine. Neurol Sci. 2005;26(Suppl 2). doi:10.1007/s10072-005-0435-4.
Sanford M. Frovatriptan: A review of its use in the acute treatment of migraine. CNS Drugs. 2012;26:791–811. doi:10.2165/11209380-000000000-00000.
Macone AE, Perloff MD. Triptans and migraine: advances in use, administration, formulation, and development. Expert Opin Pharmacother. 2017;18(4):387-397. doi:10.1080/14656566.2017.1288721.
Silberstein SD. Comparative pharmacology of frovatriptan versus other triptans and new antimigraine compounds. Headache. 2002;42 Suppl 2. doi:10.1046/j.1526-4610.2002.0420s2049.x.
Allais G, Benedetto C. Spotlight on frovatriptan: a review of its efficacy in the treatment of migraine. Drug Des Devel Ther. 2016;10:3225-3236. doi:10.2147/DDDT.2016.42974.
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Copyright (c) 2025 Agata Borkowska, Anna Kiełb, Anna Mich, Anna Kaźmierczak, Patrycja Sornek, Wiktoria Izdebska, Igor Pawlak, Radosław Ciesielski, Jakub Stanek, Klaudia Perkowska
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