Medicines for the prevention and treatment of migraine. Triptans

What are triptans and how do they work on headaches?

Triptans are medications that help relieve migraines.

The products have the following effects:

• the main effect is the effect on the vascular walls that provide cerebral blood supply - as a result, the vessels narrow, a person’s condition improves even during a prolonged migraine attack;
• high selectivity (selectivity) - the group affects only the cerebral vessels, peripheral and coronary vessels are excluded;
• the trigeminal nerve becomes inflamed during migraine, and the drugs act on its receptors, so the effectiveness of the drugs is high even in severe forms of the pathology;
• only triptans can eliminate additional symptoms of migraine - eye sensitivity to light, vomiting, nausea;
• anti-inflammatory effect - swelling is reduced.

Action of triptans

Fast-acting headache medications - triptans - have the following effect on attacks of the disease:

• stimulate vasoconstriction in the brain and its membranes, slow down blood circulation, activate special receptors, which helps relieve pain and pulsation;
• inhibit the release of specific proteins from trigeminal nerve fibers, anti-inflammatory effects and pain relief;
• reduce sensitivity to pain of the trigeminal nerve, while simultaneously affecting the receptors of the nucleus.

Migraine spray

Painkillers for migraines should be taken quickly, and the fastest remedy is a spray. It effectively eliminates pain, is administered through the nose without affecting the stomach and intestines, and its absorption time tends to be minimal. Popular types of sprays are Imigran, Dihydrergot, Sumatriptan, Prochlorperazine, Metoclopramide and Ketorolac.

Key Benefits of Triptans

Triptans for migraines are drugs, the list of which is quite large.

They have positive qualities:

• rapid onset of effect;
• reduction of accompanying symptoms;
• impact on the walls of blood vessels that ensure normal blood circulation to the brain;
• reducing the likelihood of relapse (recurrence) of migraine;
• no strong effect on blood pressure and heart rate.

In addition to the positive qualities, one can note the negative properties of triptans. The group cannot be used for prophylactic purposes. Triptans also have contraindications - coronary heart disease, blood clots, and more.

List of remedies: Sumatriptan and other varieties

The diversity of this pharmacological group is due to differences in pharmacokinetics. Below is a description of the most prominent representatives of this group of drugs:

The video will tell you more about the migraine medicine Sumatriptan:

Classification

Triptans are divided into groups. Each variety has its own active ingredient.

There are the following groups of triptans:

• first generation;
• second generation.

First generation

The first generation of triptans includes drugs with the active ingredient sumatriptan. Medicines are still popular among consumers, but have a sufficient number of contraindications. Drugs containing sumatriptan have a well-studied mechanism of action and a reduced likelihood of side effects.

List of products that belong to the first generation of triptans:

• Sumarin.
• Imigran.
• Sumamigrain.
• Sumatriptan.
• Trimigraine.
• Amigrenin and others.

Second generation

These drugs were developed to reduce the list of contraindications (compared to first-generation triptans) and improve medicinal properties. But the group has not yet been sufficiently studied, so side effects may occur after use.

Second generation triptans:

• Natriptan.
• Rizatriptan.
• Zolmitriptan.
• Relpax.
• Almotriptan and others.

How to relieve a migraine attack

Triptans for migraines are eliminated by second-generation drugs, which have convenient forms of release in the form of tablets, sprays or injections, and are characterized by increased effectiveness compared to the first generation. When choosing a remedy, it is worth remembering that if it does not stop 3 attacks in a row, then it is not suitable for the patient. You should try another drug to find one that suits your individual characteristics.

Relpax

In the list of triptans for migraines, Relpax should be highlighted, produced in the form of tablets and having eletriptan as its main component. It relieves migraine attacks, but has contraindications in the form of dysfunction of the cardiovascular system, liver, or kidney problems. Side effects are:

• pain in the back, head and chest;
• heartbeat;
• drowsiness.

Zomig

Popular among triptans for migraines is Zomig, produced in the form of tablets with the main active ingredient zolmitriptan. Contraindications for it include hypertension and hypersensitivity. The product can be used during pregnancy and lactation, but with caution and as prescribed by a doctor. It has virtually no side effects and is well tolerated by many groups of people.

Imigran spray

Contains sumatriptan and serves to suppress migraine activity. The spray is a light yellow liquid administered nasally. It is quickly absorbed and produces the desired effect within half an hour. Contraindications include pregnancy, age under 18 years, heart and kidney diseases. Side effects:

• drowsiness;
• dyspnea;
• flushes of heat or cold.

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Amigrenin during pregnancy

Amigrenin tablets contain the component sumatriptan and relieve migraine attacks with or without aura. Contraindications include pregnancy with lactation, liver, heart and brain diseases, and age under 18 years. Side effects include angina, weakness, itching. To prevent vascular spasms, it is better to start taking the drug the first 2-3 times under the supervision of a doctor.

Release forms

Basically, the drugs are available in the form of tablets with different dosages and quantities per package. It all depends on the manufacturer. This form of release should be washed down with a small amount of clean still water. It is not recommended to use juice, carbonated drink, or coffee for these purposes.

Triptans are also available in the form of a nasal spray, which has a faster effect. Due to spraying in the nasal cavity, the drug is absorbed immediately. Therefore, after 30 minutes. all migraine symptoms are reduced.

Indications for use

Triptans for migraines are drugs, a list of the main ones is presented in the article.

They have similar indications for use, regardless of classification:

• elimination of migraine attacks;

• migraine attacks are accompanied by additional symptoms (nausea, vomiting, etc.);
• status migraine is a severe disease or a continuous series of attacks lasting more than 3 days;
• Horton's disease is an inflammatory vascular disease that occurs with damage to the aorta and its branches.

How to take pills correctly

The correct use of triptan drugs so that they begin to relieve pain is to take one tablet according to the instructions:

1. First, you should try to relieve pain at home with a non-steroidal drug (analgesic or aspirin) with sweet tea.
2. If this does not help, without waiting for the aura, you should take triptans for migraines. If taken during an aura, they will not help.
3. It is better to take tablets no more than 2 times a week and no more than 2 tablets per day with a break of at least 2 hours.
4. Migraine prevention products are prohibited.

Limitations, contraindications, side effects

Triptans cannot always be taken. This group of drugs has limitations and contraindications. Additionally, side effects may develop after use. In general, triptans are well tolerated.

But the following categories of people are advised to take this group with caution:

• men over 40 years of age;
• women over 55 years of age;
• presence of bad habits - smoking, drinking alcohol and drugs;
• elevated cholesterol levels;
• diabetes;
• excess body weight;

• presence in the family of people with cardiovascular diseases.

Contraindications to the use of triptans:

• increased sensitivity to components;
• the presence of coronary heart disease or the presence of symptoms of the disease;
• peripheral vascular pathologies;
• stroke;
• bronchial asthma;
• acute allergic reaction;
• high blood pressure that cannot be controlled;
• impaired functionality of the liver and kidneys;
• child’s age up to 12 or 18 years (depending on the drug);
• simultaneous use with MAO inhibitors (a type of antidepressant) and for 14 days after their discontinuation;
• pregnancy - if the doctor believes that the benefits of use outweigh the negative effects on the fetus, then triptans can be prescribed;
• lactation.

The list of contraindications may be supplemented, so before using the products you must study the instructions. For example, it is prohibited to combine Amigrenin with lithium preparations.

Side effects from the use of triptans:

• change in taste;
• dizziness;
• drowsiness;
• impaired sensitivity;
• short-term increase or decrease in blood pressure;
• tides;
• dyspnea;
• burning of the mucous membrane of the nasal cavity and throat - a symptom occurs when using a nasal spray;
• the appearance of nausea and vomiting;
• general and muscle weakness;
• fatigue with minimal exertion;
• change in heart rate;
• skin rashes;
• feeling of heaviness and squeezing;
• dry mouth;
• pain in the abdominal cavity;
• short-term discomfort and redness at the injection site - a symptom that appears when the drug is administered subcutaneously.

How dangerous are triptans?

Triptans, like all migraine medications, can cause side effects. The list of medications is wide, so it is possible to select a remedy that will have less negative effects.

And also the danger lies in the possible lack of action from use. This happens when used incorrectly. For example, if a person took less of the drug than needed.

If you follow the dosage of medications and take the group only on the recommendation of a specialist, triptans are well tolerated. To enhance the effect of use, you can use them in complex therapy together with massage and folk remedies.

How long does it take for it to start working?

The duration of the effect may vary depending on the form of release. The fastest action is for drugs that are administered subcutaneously. When using a nasal spray, the effect occurs after 15–20 minutes.

Results of Triptans for Migraine Trial

And if a person takes pills, then the state of health improves after 30 - 40 minutes. This period is quite good, considering the cost of the drugs. If a person needs a faster effect, then it is better to use a spray or subcutaneous administration of the medication.

Types of triptans

Migraine and headache tablets are divided into first and second generation triptans. They differ in that the second generation has improved pharmacological properties, in contrast to the first open drug of this group - sumatriptan. Among the second generation there are more varieties of drugs that can be generics. The action of both generations is based on the selective activation of receptors responsible for migraine attacks.

Sumatriptan tablets

Fast-acting migraine medications were named triptans after their main constituents. The first generation is represented by sumatriptan, available in the form of tablets, injections or nasal sprays under the names Sumatriptan, Imigran, Sumamigren. Injections are considered the fastest way to deliver the substance, because already 10 minutes after administration its concentration in the blood reaches almost 100%. Medicines, regardless of the form of release, are taken at the first signs of the disease in order to prevent its development.

There is a limit on taking drugs based on sumatriptan - 300 mg per day. Patients leave the most positive reviews for the products, but there are claims that they act exclusively on the periphery and cause many side effects (dizziness, increased heart rate). The price of sumatriptan-based products is significantly less than second-generation products.

Second generation drugs

When you need to choose what helps with migraines, pay attention to second-generation triptans, which have higher properties of effectiveness and effect on the disease. Here is their list:

• Naratriptan - presented in Naramig tablets, which reduce the diameter of the carotid arteries and suppress the sensitivity of the trigeminal nerve, have contraindications in the form of angina, stroke, and hypersensitivity to the drug.
• Rizotriptan - represented by Rizamigren tablets, affects the improvement of well-being. Reduces photophobia and nausea. It is used in the treatment of attacks without an aura; contraindications include intolerance to the drug and heart disease.
• Zolmitriptan - Zomig tablets that reduce pain.
• Eletriptan is a Relpax tablet that helps treat attacks with and without aura.
• Almotriptan, Eletriptan and Frovatriptan are still undergoing clinical trials, so it is difficult to get them in Russia.

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Scheme for relieving a migraine attack

When using triptans, certain rules should be followed:

• Triptans should be taken no later than 60 minutes. from the onset of the attack.
• It is forbidden to take this group of medications for more than 9 days in 1 month, otherwise drug-type headaches will develop or the migraine will be chronic.
• When using tablets, you must maintain a minimum interval of 2 hours. For example, if the medicine did not help the first time, you can take the medicine again after at least 120 minutes. The exact details are provided in the instructions.
• Tell your doctor if the prescribed drug is ineffective. For example, if a full package of the product does not help a person, there is no need to purchase other medications without consulting a specialist.

To reduce the frequency of attacks, you must adhere to the following rules:

• eat in small portions - you need to eat 5 - 6 times a day with breaks between meals of 3 - 4 hours (servings of 200 - 300 g);
• exclude fried, salted, smoked foods;
• reduce the consumption of sweets and starchy foods;
• drink at least 1.5 liters of pure still water per day;
• exclude carbonated and alcoholic drinks, strong coffee;
• stop smoking;
• spend more time in the fresh air;
• reduce stress;
• play sports - first you can do exercises, and then find something you like (swimming, cycling, walking).

List of the best painkillers for migraines

Triptans for migraines are drugs, the list of which is quite wide. But not all medications are universal and suitable for all patients.

The best triptans include the following medications:

• Imigran spray.
• Amigrenin.
• Naratriptan.
• Naramig.
• Eletriptan.
• Almotriptan.
• Zomig.
• Sumatriptan.
• Rizatriptan.

Each of these drugs has a different composition and method of use.

Imigran spray

The drug is produced in the form of a spray for nasal use (10 or 20 mg). There are also tablets (50 or 100 mg). The main component of the product is sumatriptan. The dosage of the medication in the form of a spray depends on the age category of the person. Detailed information is shown in the table.

For children under 12 years of age, the effectiveness and safety of the drug have not been proven. This is due to a lack of research.

Amigrenin

The drug contains sumatriptan succinate. To reduce a migraine attack, it is recommended to take 100 mg. In some cases, the effect occurs when using a smaller dosage. It all depends on the individual characteristics of the body. If the attack resumes, then no more than 300 mg of the drug can be taken per day.

When Amigrenin is administered subcutaneously, the single dose is 6 mg. You should not use more than 12 mg per day. The interval between use is at least 60 minutes.

Naratriptan

The drug contains the active ingredient of the same name. Adults should take medication during a migraine attack. Dosage – 2.5 mg. If symptoms of the disease recur, re-use of the drug is possible no earlier than after 180 - 240 minutes. The maximum daily dosage is 5 mg.

Naramig

The active substance is naratriptan hydrochloride. The drug is recommended for adults to take 2.5 mg. Re-use is allowed, but not earlier than after 180 - 240 minutes. The daily dosage should not exceed 5 mg.

Eletriptan

The product contains the active ingredient of the same name. If a person has a migraine attack, the drug should be taken in an amount of 20 or 40 mg. Repeated use is possible no earlier than after 120 minutes. The maximum dosage per day is 80 mg.

Almotriptan

The main component is almotriptan. It is recommended to take 1 tablet per day. If the attack does not stop, you can reuse the drug. But the interval between use should not be less than 120 minutes.

The maximum amount of the drug per day is 2 tablets.

Zomig

The main component of the drug is zolmitriptan. Adults are recommended to take 2.5 mg. Repeated use is possible after 2 hours. If there is no therapeutic effect when using Zomig in an amount of 2.5 mg, then to relieve subsequent attacks, the use of a medication with a dosage of 5 mg is allowed. The daily amount of the drug should not be more than 10 mg.

Sumatriptan

Triptans for migraines are drugs that include the drug Sumatriptan. It contains a similar active ingredient. To reduce migraine symptoms, you need to take 100 mg of medication. The dosage per day should not exceed 300 mg.

Subcutaneous administration of the drug in an amount of 6 mg is possible. The maximum dosage per day is 12 mg.

Rizatriptan

Contains rizatriptan. Dosage for adults – 1 tablet. Repeated use is possible no earlier than after 2 hours. The maximum dosage per day is 30 mg.

Medicines containing triptans

Or they are also called drugs of the triptan group or class:

• almotriptan;
• eletriptan;
• frovatriptan;
• naratriptan;
• Rizotriptan;
• zolmitriptan;
• sumatriptan.

Today there are two groups:

First generation triptans . This group includes sumatriptan, the most studied drug whose action is aimed at relieving migraine attacks by selectively activating 5-HT1B/D receptors.

Second generation triptans . These include naratriptan, rizotriptan, zolmitriptan, frovatriptan, eletriptan and almotriptan. Such drugs are characterized by improved pharmacological properties, in contrast to the first generation agonist - sumatriptan.

However, it is worth noting that drugs such as almotriptan, elitriptan and frovatriptan are still undergoing clinical trials and have not received permission for use in Russia.

Triptans: instructions for use

According to numerous clinical studies, the high effectiveness of triptans has been confirmed in 60% of patients. It is recommended to use them as soon as possible after the onset of migraine. The noticeable effect appears within 2-4 hours and lasts for several hours.

The optimal dose, which allows migraine relief for most patients, is 1 tablet. In the case of sumatriptan, the dosage is 50 mg; for eletriptan - 40 mg; for zolmitriptan - 2.5 mg. Repeated use is possible no earlier than after 2 hours. The daily dose of sumatriptan should not exceed 300 mg; zolmitriptan - 15 mg; eletriptan - 160 mg.

Take the tablet whole with plenty of water. The spray is used intranasally at a dose of 20 mg in one nostril.

It is not advisable to use more than two days a week. The drugs are contraindicated in case of stroke, coronary heart disease, uncontrolled arterial hypertension, as well as when taking medications incompatible with triptans.

Where can you buy triptans for migraines and what is their cost?

Triptans are available in different dosage forms such as injection, nasal spray and tablets. The price varies depending on the form of release, manufacturer and dosage. On average, the price for one tablet is 90–150 rubles, and for a 20 ml bottle it ranges from 300–1300 rubles.

You can buy triptans in regular pharmacies or online pharmacies in Russia. However, it is worth remembering that some of the drugs are available only by prescription. There is no need to self-medicate, but rather consult a doctor to establish a reliable diagnosis.

Medicines are not always at hand; find out how to relieve a migraine attack if you don’t have the necessary medications nearby. If you are interested in how to treat a disease with folk remedies, you can read about them here.

What can replace triptans for migraines?

Most people use analgesics to treat migraines. The disease is neurological in nature, the mechanism of action is associated with spasm of blood vessels, thanks to which blood flows to the brain. Then there is pain.

If you use analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs), the effect will not be as significant as with triptans. NSAIDs can be taken for mild attacks. But if the pain is severe, then it is better to purchase a medication from the triptan group. It is also possible to use NSAIDs if there is no effect from using the spray. For example, Imigran.

When the discomfort is very severe, even triptans may have no effect. In this case, narcotic analgesics are prescribed. They are dispensed from pharmacies strictly according to a prescription; the decision on the prescription is made by a specialist.

If the discomfort increases gradually and does not feel like a migraine, triptans will not be effective. It is better to replace drugs with analgesics or NSAIDs.

Points by which you can distinguish a migraine from a headache:

• Strong pulsation. With migraines, you can notice this point. Moreover, the pulsation is felt in the head if you put your finger to your temple. And with ordinary pain, the discomfort is dull in nature and does not greatly distract from life activities.

• One-sided pain. Migraines occur on both sides, but this is a rare occurrence. Mostly discomfort manifests itself on the left or right. And the headache is often bilateral.
• The appearance of flashes of light. About 25% of people with migraines notice this symptom. It's called an aura. The symptom manifests itself in the form of impaired vision - flashes of light, the picture looks like pixels. With a normal headache, these symptoms do not occur.
• Feeling of weakness and tingling. Some people have difficulty pronouncing words.
• Nausea. The symptom is noticeable in many people with migraines. In serious cases, vomiting occurs.
• Sensitivity to odors. This symptom occurs during migraine.
• Vivid signs are not relieved by over-the-counter medications. For ordinary headaches, you can take drugs with a weak effect, and they will make a person feel better. For example, Ibuprofen, Nurofen.
• Prolonged manifestation of pain. A migraine attack can last a long time - from several hours to days.

The correct method for relieving migraine attacks:

• When fixing the phase of the precursor or aura, give the patient motilium (dosage 10 mg), aspirin (dosage 1000 mg) and drink strong sweet coffee or other caffeine-containing drink;
• After 45 minutes, if the pain does not subside, you need to take a triptan tablet;
• For the treatment of migraine with a pronounced aura phase, a triptan is prescribed to the patient for headaches, and aspirin is prescribed during the manifestation of the aura itself;
• If after taking a nonspecific analgesic there is no relief for three attacks, you should immediately take a triptan.

After two days, according to statistics, approximately half of the patients experience pain again. When signs of relapse occur, it is recommended to take another tablet of the drug that was used previously. Treatment should be continued without exceeding the maximum daily dose two hours after the onset of the first symptoms. If the pain returns mildly, Naproxen or another similar drug may be sufficient.

Severe migraine attacks, in which the headache does not go away both after triptans and after conventional analgesics, require a special treatment regimen. The doctor combines triptans, anticonvulsants and beta blockers, which include drugs such as Labetalol, Betaxolol, Penbutolol, Nadolol.

The feasibility of using triptans in the treatment of migraine has been proven by clinical practice. But the effect of triptans on the human body with long-term use has not been studied enough, which is why their research continues to this day.

Find out more: How to reduce the frequency of migraine attacks? All you need to know about migraine treatment

Comparative characteristics of the clinical effectiveness of triptans

Judging by the information provided in the instructions for use of the drugs, a comparative table can be drawn up about popular drugs.

Triptans prices

The cost of drugs varies. It depends on the form of release, manufacturer, city. And also the cost varies for each pharmacy chain. The price range for triptans is from 100 to 1000 rubles.

Migraine is a disease that can affect anyone. There are medications to relieve attacks, they are called triptans. This group has a large list of medications. Thanks to its use, you can eliminate the unpleasant symptoms of migraine. The most important thing is to consult a doctor to select a medication and adhere to the information specified in the instructions for use.

Article design: Vladimir the Great