Medicine 2: Triptans

Medicine 2: Triptans

What is it?

Triptans, also known as serotonin receptor agonists, are a class of drugs used to treat acute attacks of migraines. They are available in different formulations and include:

1. Sumatriptan

2. Naratriptan

3. Zolmitriptan

4. Rizatriptan

5. Almotriptam

6. Frovatriptan

7. Eletriptan

How does it work?

Triptans work by binding to serotonin receptors in the brain, called 5-HT1B and 5-HT1D. When you have a migraine, the blood vessels in your head become swollen and enlarged. When triptans attach to 5-HT1B receptors on blood vessels in the brain, they cause these vessels to narrow, which reduces the pain.

When triptans attach to the neurogenic and central 5-HT1D receptors, they prevent the release of certain protein-like molecules known as vasoactive neuropeptides by inhibiting trigeminal nerve activation and blocking the transmission of pain signals to the central nervous system.¹

What is the efficacy?

Method: Several studies were conducted to assess the effectiveness of triptans in treating menstrual migraine. Both acute treatment and short-term prevention were evaluated.^2,3,4

Results: Triptans like sumatriptan, rizatriptan, zolmitriptan, and almotriptan provided rapid relief from menstrual migraines. Many women achieved pain-free status within 2 hours, with sustained relief up to 24 hours. Frovatriptan 2.5 mg twice daily, taken for about 5–6 days around menstruation, significantly reduced the frequency, severity, and recurrence of menstrual migraines.

Conclusion: Based on the studies, triptans are effective and well-tolerated treatments for menstrual migraines. As acute therapy, they provide fast and effective relief from migraine attacks, and as short-term prevention, especially with frovatriptan, they help prevent migraines when taken in the days around menstruation.

Side-effects:

Short-term effects: Nausea, Dizziness, Tingling

Long-term effects: Coronary vasoconstriction, Paresthesia, Arrhythmias, Myocardial Infarctions, and Strokes.¹

References

1. Nicolas S, Nicolas D. Triptans. InStatPearls [Internet] 2024 Feb 25. StatPearls Publishing.

1. Zhang H, Qi JZ, Zhang ZH. Comparative efficacy of different treatments for menstrual migraine: a systematic review and network meta-analysis. The Journal of Headache and Pain. 2023 Jul 3;24(1):81.

2. Hu Y, Guan X, Fan L, Jin L. Triptans in prevention of menstrual migraine: a systematic review with meta-analysis. The Journal of Headache and pain. 2013 Dec;14(1):7.

3. Khoo CC, Liu CC, Lu M, Huang YC, Weng HY. Acute and preventive treatment of menstrual migraine: a meta-analysis. The Journal of Headache and Pain. 2024 Sep 4;25(1):143.