On December 28, 1992, the FDA approved the first of a class of medications that many Migraineurs would come to call "miracle drugs." That drug was the injectable form of sumatriptan (Imitrex®, Imigran®), the first of the triptans. The more technical name for this class of medications is selective serotonin receptor agonists. Triptans are not pain medications as we traditionally think of them. Traditional pain medications don't end the pain. They simply increase our tolerance to it -- temporarily. Unless the Migraine attack has run its course while a pain medication is working, the symptoms will return when the pain medication wears off.Triptans are termed abortive Migraine medications. They cannot prevent Migraines. They are used to abort a Migraine attack, to stop the attack itself and the associated symptoms. Drugs in this class need to be taken early in the Migraine attack to be most effective. In addition to Migraine attacks, triptans are also sometimes helpful for cluster headaches.
For an idea of how a Migraine affects the brain and the role of serotonin, click HERE.
The triptan family has grown since then. Below a list of the triptans to date along with when they were approved in the United States by the FDA. Some of them were available in European countries before they became available in the U.S.
- December 28, 1992: sumatriptan (Imitrex®, Imigran®) injections
- June 1, 1995: sumatriptan (Imitrex®, Imigran®) tablets
- August 26, 1997: sumatriptan (Imitrex®, Imigran®) nasal spray
- November 25, 1997: zolmitriptan (Zomig®) tablets
- February 10, 1998: naratriptan (Amerge®, Naramig®) tablets
- June 29, 1998: rizatriptan (Maxalt®) tablets and rizatriptan orally dissolvable (Maxalt-MLT®) tablets
- February 13, 2001: zolmitriptan orally dissolvable (Zomig-ZMT®) tablets
- May 7, 2001: almotriptan (Axert®) tablets
- November 8, 2001: frovatriptan (Frova®) tablets
- December 27, 2002: eletriptan (Relpax®) tablets
- September 30, 2003: zolmiatriptan (Zomig®) nasal spray
Although these drugs belong to the same class and have many of the same characteristics, it is worth note that they also have differences. If one of these drugs does not work adequately for a person, it is well worthwhile to try other triptans before abandoning them altogether. Because they are selective serotonin receptor agonists, they work on different serotonin receptors, and thus may produce different results and effects.
Triptans should only be prescribed after a thorough examination to rule out contraindications. Those contraindications include:
- uncontrolled hypertension
- family history of coronary artery disease or heart attacks
- history of stroke
- risk factors for coronary artery disease
- uncontrolled diabetes
- high cholesterol levels
For detailed information on the individual triptans, please consult these profiles:
