Triptans are a class of acute migraine medications introduced with sumatriptan in 1991 — the first drug class developed specifically for migraine pathophysiology. Seven members are approved in most markets. They share the same core mechanism (5-HT1B/1D agonism) and differ in onset speed, duration of action, and side-effect profile.
For about 30 years, triptans were the standard acute treatment benchmark. The newer gepant class (CGRP receptor antagonists) has emerged as an alternative, particularly for patients with cardiovascular contraindications to triptans.
The seven triptans
| Drug | Brand | Onset | Duration | Notable |
|---|---|---|---|---|
| Sumatriptan | Imitrex | 10–15 min (inj), 30–60 min (tablet) | Short half-life | The original; injection is fastest acute option |
| Rizatriptan | Maxalt | 30 min (ODT/MLT) | Short | Orally-disintegrating form bypasses nausea-affected absorption |
| Naratriptan | Amerge | 1–2 hours | Long (5–6h half-life) | Slower onset but used for menstrual migraine prevention |
| Zolmitriptan | Zomig | 30–60 min | Medium | Nasal spray + tablet + ODT |
| Almotriptan | Axert | 30 min | Medium | Generally well-tolerated |
| Eletriptan | Relpax | 30 min | Medium-long | High efficacy, more drug-drug interactions |
| Frovatriptan | Frova | 1–2 hours | Long (26h half-life!) | Very long-acting; used for menstrual migraine mini-prophylaxis |
The choice between them is driven by personal response (which works best for you), specific use case (mini-prophylaxis vs acute attack), formulation preference (tablet vs nasal vs injection), and insurance coverage.
Mechanism
Triptans act on two serotonin receptor subtypes:
- 5-HT1B receptors on cranial blood vessels — activation causes vasoconstriction, reversing the vasodilation phase of migraine.
- 5-HT1D receptors on trigeminal nerve endings — activation inhibits release of CGRP and other neuropeptides, reducing pain signalling and neurogenic inflammation.
The vasoconstriction effect is what makes triptans contraindicated in patients with cardiovascular disease. The vessels they constrict aren’t only cranial — coronary constriction is a small but real effect.
Cardiovascular contraindications
Triptans are contraindicated in patients with:
- Known coronary artery disease.
- Prior myocardial infarction or stroke.
- Uncontrolled hypertension.
- Peripheral vascular disease.
- Hemiplegic migraine.
- Basilar migraine.
- Pregnancy (relative — case-by-case decision).
This is why gepants (CGRP receptor antagonists) have an important niche — they work without vasoconstriction, making them safer for cardiovascular-risk patients.
Timing — earlier is better
Triptans work better the earlier they’re taken in an attack. Once central sensitisation occurs (typically signalled by the onset of allodynia — pain in response to normally non-painful touch), response rates drop significantly.
Practical timing guidance from headache specialists typically includes:
- Take at first definite recognition of an attack.
- Don’t wait for the headache to become severe.
- If you got a partial response, a second dose 2 hours later is standard for some triptans (check your specific prescription).
- If you respond consistently to one triptan, that’s likely your best choice — switching for variety isn’t recommended.
Overuse risk
Triptans count toward medication overuse headache (MOH) at ≥ 10 days/month for 3+ months. Above this threshold, the risk of transforming episodic migraine into chronic migraine rises significantly.
For patients hovering near 10 acute medication days per month, a preventive medication conversation with the prescriber is the right move — taking more triptan to control more attacks is the trap that creates chronic migraine.
Where triptans sit in 2026
The acute migraine treatment landscape has expanded:
- Triptans — still the standard for most acute migraine, when not cardiovascular-contraindicated. Cheap, generic, well-known side-effect profile.
- Gepants (ubrogepant, rimegepant, zavegepant) — acute treatment alternative without cardiovascular contraindications. More expensive, newer.
- Ditans (lasmiditan) — selective 5-HT1F agonists. No vasoconstriction. Sedating side effects limit some patients.
- NSAIDs + combinations — still useful, particularly when triptans aren’t available or appropriate.
- Caffeine combinations (Excedrin Migraine) — over-the-counter option with the caffeine-rebound caveat.
Triptans remain first-line for most uncomplicated acute migraine, but they’re no longer the only choice.
What this isn’t
Not a recommendation to take any specific triptan or to escalate from one to another. That decision belongs with your prescriber, who knows your cardiovascular history, drug interactions, and prior response.