Triptans for migraine and headache

This page from Great Ormond Street Hospital explains about the medicines called triptans. Triptans are a group of medicines used to treat migraine or headache. They are also known as 5HT1-receptor agonists, which refer to the particular substance in the brain (5HT 1B/1D or serotonin) on which the medicines act.

Triptans do not prevent migraine or headache but they act on the pain once a migraine or headache has developed. There are several medicines in the triptan group including:

  • „„Sumatriptan (available under the brand name Imigran®)
  • „„Zolmitriptan (Zomig®)
  • „„Rizatriptan (Maxalt®)

If one triptan does not work or causes side effects, your doctor will suggest another.
Some types of triptan are not licensed for use in children. Medicines are often used ‘off licence’ in children for a number of reasons for example limited data available for a specific use in children. This is not necessarily hazardous but should be explained and agreed before use. Your doctor will explain this further to you.

How are they given?

Triptans should be given as soon as a migraine or headache develops, while it is still mild to moderate. In many people, triptans do not work if taken during a migraine aura. Follow the instructions on the packet for the maximum dose per attack and in a week. 

Triptans come in various formats.

„„Tablets to be taken whole by mouth

Sumatriptan, Zolmitriptan and Rizatriptan

Give to your child with plenty of water. If possible, they should swallow the tablet whole – for further information on giving your child tablets, see our information sheet or our short video film 

„„Tablets to be melted on the tongue

Zolmitriptan and Rizatriptan

Give to your child to place on their tongue while the tablet slowly dissolves. They may want a drink of water afterwards.

„„Injection under the skin (subcutaneously or SC)

Sumatriptan

We will show you how to give a subcutaneous injection. You can also read our information sheet to remind you.

„„Nasal spray

Sumatriptan and Zolmitriptan

Ask your child to lean slightly forwards and spray a single dose inside one nostril. Unlike an inhaler, they do not need to take a deep breath after the spray. For further information, see our information sheet or our short video film.

Who should not take triptans?

People with the following conditions should discuss taking triptans with their doctor.

  • „Hypersensitivity to triptans or any of their ingredients
  • „„Children aged under 12 years
  • „„Existing liver problems
  • „„Existing heart disease or uncontrolled high blood pressure
  • „„Depression being treated with certain medicines such as fluoxetine or fluvoxamine

What are the side effects of triptans? 

The following side effects have been reported. If your child experiences them, please discuss with your doctor or pharmacist.

  • „„Chest pain
  • „„Jaw, neck or chest pressure
  • „„Skin irritation
  • „„Numbness
  • „„Nausea
  • „„Flushing

The nasal spray format may cause a strange taste in the mouth or irritation of the nose and mouth.

If triptans are taken too often, they may cause an ‘overuse’ headache. If your child is taking triptans more than two or three times a week, discuss this with your doctor.

Triptans and other medicines

Always check with your doctor or pharmacist before giving your child any other medicines, including herbal or complementary medicines. 

  • „„Other pain relief medicines such as paracetamol and ibuprofen can be taken 30 to 60 minutes before a triptan medicine.
  • „„Certain antibacterials, such as erythromycin, clarithromycin and ciprofloxacin
  • „„Certain antifungals, such as itraconazole or ketoconazole
  • „„Certain antivirals, such as indinavir, nelfinavir and ritonavir

Important information

  • „„Keep medicines in a safe place where children cannot reach them.
  • „„The medicine should be kept in a cool, dry place out of direct sunlight and heat.
  • „„If your doctor decides to stop treatment or the medicine passes its expiry date, return any unused medicine to the pharmacist. Do not flush them down the toilet or throw them away.
Compiled by: 
The Neurology Department in collaboration with the Child and Family Information Group
Last review date: 
February 2015
Ref: 
2014F1564

Disclaimer

Please read this information sheet from GOSH alongside the patient information leaflet (PIL) provided by the manufacturer. If you do not have a copy of the manufacturer’s patient information leaflet please talk to your pharmacist. A few products do not have a marketing authorisation (licence) as a medicine and therefore there is no PIL.

For children in particular, there may be conflicts of information between the manufacturer’s patient information leaflet (PIL) and guidance provided by GOSH and other healthcare providers. For example, some manufacturers may recommend, in the patient information leaflet, that a medicine is not given to children aged under 12 years. In most cases, this is because the manufacturer will recruit adults to clinical trials in the first instance and therefore the initial marketing authorisation (licence) only covers adults and older children.  

For new medicines, the manufacturer then has to recruit children and newborns into trials (unless the medicine is not going to be used in children and newborns) and subsequently amend the PIL with the approved information. Older medicines may have been used effectively for many years in children without problems but the manufacturer has not been required to collect data and amend the licence. This does not mean that it is unsafe for children and young people to be prescribed such a medicine ‘off-licence/off-label’. However, if you are concerned about any conflicts of information, please discuss with your doctor, nurse or pharmacist.