Sumatriptan

Sumatriptan was the first triptan to come onto the market. It was developed specifically to treat acute migraine attacks and acts in a targeted way on the mechanisms that cause migraine pain.

Sumatriptan narrows the dilated blood vessels in the head, for example in the meninges, and inhibits the release of inflammatory substances. As a result, not only the headache but also accompanying symptoms such as nausea and sensitivity to light are relieved.

Well-known brand names are Imigran® and numerous generics.

Sumatriptan acts as a selective serotonin receptor agonist:

Mechanism of action: 1. Sumatriptan activates 5-HT1B/1D receptors on the blood vessels of the head 2. This leads to constriction of dilated cranial blood vessels 3. The release of inflammatory mediators (CGRP, substance P) is inhibited 4. The transmission of pain signals is blocked

Effect on migraine symptoms:

• Headache: relief through vasoconstriction
• Nausea: improvement through central action
• Sensitivity to light/noise: decrease
• Aura: is not affected

Time course:

• Tablet: onset of action after 30-60 minutes
• Nasal spray: onset of action after 15-30 minutes
• Injection: onset of action after 10-15 minutes

Sumatriptan is suitable for:

• Acute migraine attacks (with or without aura)
• Cluster headache (injection)
• Adults aged 18 to 65 (use in patients over 65 is not recommended)

Important notes:

• Take only after any aura has subsided
• Not suitable for migraine prophylaxis
• Not for hemiplegic or basilar migraine

Not suitable in cases of:

• Cardiovascular disease
• Uncontrolled high blood pressure
• Previous TIA or stroke
• Use of ergotamines or MAO inhibitors

Tablets:

• 50 mg (standard dose)
• 100 mg (if the effect is insufficient)

Nasal spray:

• 10 mg, 20 mg

Subcutaneous injection:

• 6 mg (for severe attacks)

Suppositories:

• 25 mg

Recommended dosage:

• Adults: 50 mg, a further dose no sooner than 2 hours later only if symptoms that had subsided return
• Maximum for tablets: 300 mg in 24 hours
• Maximum for nasal spray: 2 doses in 24 hours
• Maximum for injection: 2 times 6 mg (12 mg) in 24 hours
• Treat a maximum of 2 attacks per week with a triptan

Tablets:

• Take at the first signs of the headache phase
• Swallow with water
• Not during the aura phase
• Repeat only if symptoms that had subsided return, no sooner than 2 hours later

Nasal spray:

• Spray into one nostril
• Do not inhale at the same time
• Keep your head upright
• Advantageous in case of vomiting

Timing:

• Taking it early is more effective
• Not during the aura, but when the headache begins
• If the headache returns: second dose no sooner than 2 hours later

If the first dose does not work: No second dose for the same attack! Other pain relievers (e.g. ibuprofen) can be tried.

Sumatriptan must not be taken in cases of:

• Coronary heart disease (angina pectoris, heart attack)
• History of stroke or TIA
• Peripheral arterial occlusive disease
• Uncontrolled high blood pressure
• Severe hepatic insufficiency
• Hemiplegic or basilar migraine
• Concurrent use of ergotamine derivatives
• MAO inhibitor therapy or less than 2 weeks after it

Caution in cases of:

• Controlled high blood pressure
• Cardiovascular risk factors
• Hepatic or renal insufficiency
• Sulfonamide allergy

Pregnancy: Only if strictly indicated. Experience is available, but caution is advised.

Common (1-10%):

• Tingling, feeling of warmth, flushing
• Feeling of weakness
• Dizziness
• Nausea (also migraine-related)
• Fatigue

Triptan-specific sensations (common):

• Feeling of tightness in the chest or throat
• Feeling of pressure
• Heaviness in the arms or legs
• These symptoms are usually harmless!

Uncommon:

• Increase in blood pressure
• Visual disturbances
• Shortness of breath

Rare:

• Cardiac arrhythmias
• Coronary spasms
• Allergic reactions
• Serotonin syndrome (when combined)

Important: Chest tightness and a feeling of pressure are typical triptan side effects and are usually not cardiac in origin. However, see a doctor if symptoms are persistent or severe.

Do not combine with:

• Ergotamine preparations (keep 24 hours apart!)
• Other triptans on the same day
• MAO inhibitors (also within 2 weeks after stopping them)
• Serotonergic medications (risk of serotonin syndrome)

Caution with:

• SSRI/SNRI antidepressants (serotonin syndrome possible)
• Lithium
• St. John's wort
• Tryptophan

No relevant influence:

• Common pain relievers (ibuprofen, paracetamol)
• Antiemetics (metoclopramide)
• Hormonal contraception