Neurological symptoms

• Potentially serious neurological conditions should be excluded prior to treatment with triptans and further investigation may be recommended if you have atypical neurological symptoms or they are suggestive of a more  serious underlying cause of headache requiring emergency or urgent referral to secondary care.

Cerebrovascular events

• It should be noted that migraineurs may be at increased risk of certain cerebrovascular events (e.g. CVA, TIA).

Ischaemic heart disease

• Following administration, triptan products can be associated with transient symptoms including chest pain and tightness which may be intense and involve the throat. Where such symptoms are thought to indicate ischaemic heart disease, no further doses should be taken, and you should consult your GP.

Seizures • Sumatriptan should be used with caution if you have a history of seizures or other risk factors which lower the seizure threshold, as seizures have been reported in association with sumatriptan.

Medication overuse headache (MOH)

• Prolonged use of any type of painkiller for headaches can make them worse. If this situation is experienced or suspected, medical advice should be obtained, and treatment should be discontinued. The diagnosis of MOH should be suspected if you have frequent or daily headaches despite (or because of) the regular use of headache medication.

• As triptans taken as frequently as 10 days or more per month can result in medication overuse headache, you should not exceed this frequency of administration without supervision from your GP or specialist. Furthermore, we advise you to restrict the use of acute medication to a maximum of 2 days per week.

Ineffective treatment

• If treatment is ineffective on two or more treatment courses, you should consider seeing your GP . Poor response to triptans may be due to using triptans too little or too late in the attack, or, conversely, used too much (medication overuse).

Lactose

• Some triptan products may contain lactose, if you have rare hereditary problems of galactose-intolerance, the Lapp lactase deficiency or glucose-galactose- malabsorption. you should not take products. Check the product SmPC for specific content information.

Blood pressure

• Triptan products should be given with caution iif you have mild controlled hypertension, since transient increases in blood pressure and peripheral vascular resistance have been observed in a small proportion of people . It is recommended that you have your blood pressure measured before treatment with triptan products.

Angioedema

• Hypersensitivity reactions, including angioedema (e.g. facial oedema, tongue swelling and pharyngeal oedema) may occur in people treated with triptans. Treatment should be discontinued, and medical advice sought immediately if you suspect a hypersensitivity reaction.

Other considerations

• Triptan products should be administered with caution if you have a conditions that may affect the absorption, metabolism or excretion of the drug. If in any doubt, please make us aware so we can consult with the appropriate healthcare professional before approving the supply.

Migraine management

•Predisposing factors to Migraine should be identified and managed, though they may not always be avoidable.

Predisposing factors can include (but are not limited to): 

o Stress o Depression or anxiety o Menstruation o Menopause

• Identifying and avoiding trigger factors can reduce your frequency of attacks, though many attacks have no obvious trigger and those that are identified may not be avoidable .

• A headache diary may be used to record the frequency, duration, and severity of headaches, to monitor the effectiveness of treatment, and to use as a basis for discussion with your pharmcist or GP.

• For comprehensive guidelines on migraine management, see

Clinical Knowledge Summaries:

Treatment-summaries/migraine/

Reasons to not take Triptans include:

• Hypersensitivity to the active substance(s) or to any of the excipients or trace residuals. See SmPC.

• If you are under 18 years of age or over 65 years of age.

• Diagnosis has not been made or is unclear.

• Known or suspected pregnancy.

• If you are  Breast-feeding.

• If you have renal or hepatic impairment.

• If you are at high risk of cardiovascular disease.

• If you have a history of myocardial infarction.

• If you have ischaemic heart disease, or symptoms or signs consistent with ischaemic heart disease.

• You have coronary vasospasm (Prinzmetal’s angina).

• You have peripheral vascular disease.

• You have a history of cerebrovascular accident (CVA) or transient ischaemic attack (TIA).

• You have moderate or severe hypertension.

• You have mild uncontrolled hypertension.

• Management of hemiplegic, basilar or ophthalmoplegic migraine.

• You have known or suspected secondary headache disorder.

• You have risk factors for ischaemic heart disease (e.g. a heavy smoker, diabetes) without prior cardiovascular evaluation.

• You have Prolonged aura, especially aura persisting after resolution of the headache.

• You have a chronic migraine.

• You have atypical headaches.

• You have significant arrhythmias or heart failure.

• You have known hypersensitivity to sulphonamides.

• You are  taking medications that would contraindicate the supply of the selected triptan product (see Product interactions).

Choice of triptan product

If you have previously been prescribed a triptan by your GP and need a repeat simply choose the medicine and strength and answer the online clinical questionnaire. If you have not had a triptan before the following information is a guide to the medicine which may be most appropriate for you. If you are uncertain after completing the clinical assesment please discuss further with our pharmacists before purchase. Our clinicians will only be able to supply your chosen medicine to you after completing your purchase if we deem it safe for you. 

• Oral sumatriptan (50 mg or 100 mg) is recommended as the first-line triptan for most people.

As the effectiveness of one triptan product does not predict the response of another triptan, an alternative triptan may be considered if your current triptan product is not effective.

The British Association for the Study of Headache (BASH) recommend that an alternative triptan product is trialled following two treatment failures with a particular triptan, as 70% of patients that experienced treatment failure in two attacks also failed to respond in the third attack.

If in doubt first consult with one of our pharmacists or your GP to consider trialling a different triptan, dose or route of administration to find the most effective one.

Rizatrriptan Oro-dispersible or Maxalat Melt can be used in situations in which liquids are not available, or to avoid the nausea and vomiting that may accompany the ingestion of tablets with liquids.

Naratriptan and frovatriptan are better tolerated than sumatriptan 100 mg, though they may not be as effective.

If vomiting restricts oral treatment, zolmitriptan nasal spray could be considered as an option for you to try.

Like all medicines, this medicine can cause side effects, although not everybody gets them. Some of the symptoms below could be part of the migraine attack itself.

Common side effects (may affect up to 1 in 10 people): • abnormal sensations such as tingling in your fingers and toes or skin that is sensitive to touch • feeling sleepy, dizzy or warm • headache • uneven heart beat • feeling sick, vomiting • stomach pain • dry mouth • muscle weakness or muscle pain • feeling weak • heaviness, tightness, pain or pressure in throat, neck, arms and legs or chest • difficulty in swallowing

Uncommon side effects (may affect up to 1 in 100 people): • very fast heart beat • slightly higher blood pressure, increase in blood pressure only lasting a short time • increase in the amount of water you pass (urine) or in how often you need to pass water

Rare side effects (may affect up to 1 in 1,000 people): • allergic/hypersensitivity reactions including lumpy rash (hives) and swelling of the face, lips, mouth, tongue and throat. If you think that this product is causing an allergic reaction, stop using it and contact your doctor straight away

Very rare side effects (may affect up to 1 in 10,000 people): • angina (pain in the chest, often brought on by exercise), heart attack or spasm of the blood vessels of the heart. If you notice chest pain or shortness of breath after taking Zolmitriptan orodispersible tablets, contact your doctor and do not take any more. • spasm of the blood vessels of the gut, which can cause damage to your gut. You may notice stomach pain or bloody diarrhoea. If this happens, contact your doctor and do not take any more. • feeling a sudden need to urinate (urinary urgency.