Triptans and Migraines

Pain expert Dr. Scott Fishman answers questions about headache pain:

Q: How have the new generation of drugs called "triptans" changed the treatment of migraines?


A: The new class of drugs, called triptans, came on the market in the early 1990s and has been a huge relief for migraine headache sufferers. Second generation triptans, which may be even more useful, are now available as well.

These drugs were developed as researchers learned more about the chemistry of migraines. For years, doctors believed that migraines were caused largely by pressure on nerves from dilated blood vessels. Until recently, the leading drugs to fight these headaches were ergotamines (brand names Cafergot, Wigraine) or an injectable drug, dihydroergotamine mesylate (DHE). These drugs caused blood vessels to constrict.

But as scientists refined scanning and imaging tools and delved into genetic research, they downgraded the "vascular theory" from main culprit to an accomplice and identified other sources. They figured something was setting off a chemical or electrical chain reaction affecting blood vessels and head muscles as well as the flow of powerful neurochemicals. When researchers confirmed that the neurotransmitter serotonin was mixed up in the migraine stew, pharmacologists proceeded to create a drug to interact with serotonin and hinder the migraine chemistry. The first of this new group of drugs was sumatriptan (brand name Imitrex).

The development of sumatriptan also helped to fuel further research. "The new drug sumatriptan changed the ways doctors think about migraines," says Dr. Elizabeth Loder, Director of the Headache Management Program at Spaulding Rehabilitation Hospital in Boston. "They became a real medical condition that could be treated, not just a woman's problem."

The pharmacology of headache treatments has been gaining steady momentum since the development of triptans. Sumatriptan and other first generation drugs are not only fast-acting (halting migraine pain within twenty minutes), but also combat accompanying symptoms like nausea, vomiting, and light sensitivity. The side effects are usually minimal (although not in everyone) - mainly dizziness, tingling, a warm sensation, and a light feeling of pressure in the chest. This may be why these drugs are not advised for people with heart problems or high blood pressure.

Since sumatriptan (Imitrex) came out, other even more advanced varieties of triptans have come on the market. Zolmitriptan (Zomig), naratriptan (Amerge) and rizatriptan (Maxalt) are now available in the United States and manufacturers have devised pill and nasal forms of these drugs.

The new generation of triptans are special because they are like a bouncer in a rough bar. When a fight or headache breaks out, they are there to halt further hostilities. Unlike many migraine medications that work only if they are taken when early signs appear, these new generation drugs can stop a fully launched headache cold. Even though they come only in tablets, their effects may last longer than sumatriptan.

This new generation of drugs also helps reduce nausea and a patient's sensitivity to light and sound, all without sedation. They do not work for everyone, but for some people they are a miracle. The newcomer, rizatriptan (Maxalt), has an ingenious delivery system. It is available in wafer form and dissolves on the tongue within seconds. This is particularly helpful to migraine sufferers who may not have a glass of water handy.

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