Chapter 5, Episode 2: Triptans and Ditans for Migraine

This content has been medically reviewed by Dr. Shivang Joshi and Dr. Beth Robertson

Triptans and ditans are acute treatments used to reduce or eliminate the symptoms of a migraine attack. While they both work on serotonin receptors in the brain, they differ in side effects, risks and which specific receptors they target.

Triptans have been the “gold standard” for acute migraine treatment since their development in the 1990s. They treat migraine by targeting specific serotonin receptors on nerves and blood vessels in the brain. This is thought to narrow blood vessels and reduce the release of certain neurotransmitters to decrease pain and inflammation.

There are seven triptans FDA approved for adults in the US, a few of which are also approved for use in children and adolescents. Rizatriptan is FDA approved for children aged 6 years and older. Sumatriptan and naproxen combination as well as almotriptan are FDA approved for children aged 12 years and older. All triptans are available in pill form but some also come in dissolving oral tablets, nasal sprays and subcutaneous injections using pre-filled auto-injectors. The seven triptans differ in their onset or how quickly they work and how long they last, but all are thought to be most effective when taken at the beginning of a migraine attack.

The most common side effects include chest tightness or heaviness, neck pain, dizziness, nausea, flushing, and tingling or other skin sensations. For most people, these side effects are temporary but often can be minimized with a lower dose or a longer acting triptan.

Triptans are typically avoided in people who have a history of hemiplegic migraine or migraine with brainstem aura, heart disease, stroke or transient ischemic attack, uncontrolled high blood pressure, peripheral vascular disease, or significant liver disease.

They should not be taken with ergotamine, dihydroergotamine, monoamine oxidase inhibitors or another triptan.

There is not enough information at this time to know whether triptans are safe during pregnancy.

Ditans are a newer class of medication that work on one specific serotonin receptor found on nerves responsible for headache but not on blood vessels. Because of this difference, ditans may be a safer acute treatment than triptans for people with cardiovascular risk factors.¹

There is one ditan currently approved for acute migraine treatment in adults, called lasmiditan.

The most common side effects are dizziness, sedation, fatigue, as well as numbness or tingling. There is a warning to avoid driving or using machinery for at least 8 hours after taking a dose.²

Lasmiditan is generally not recommended for people who consume alcohol, have severe liver disease, plan to become pregnant or are breastfeeding.

A provider may also prescribe lasmiditan with caution if a person uses…²

  • Antidepressants
  • Sedatives or other medications that cause sleepiness
  • Medications that can lower heart rate

Lasmiditan is considered a schedule 5 controlled substance in the US because it has a small risk of abuse.³

Like many other acute pain medications, triptans have the potential to cause medication overuse headache when taken 10 or more days per month for more than a few months. It is not yet known whether lasmiditan can cause medication overuse headache.

Overall, lasmiditan and the seven triptans vary in their onset, duration, side effects, risks and benefits. It’s important to work with your provider to find a treatment plan that works best for you.

For more information, visit migrainedisorders.org.

References

  1. https://www.health.harvard.edu/blog/lasmiditan-new-first-in-class-drug-treatment-approved-for-migraine-2019121218416
  2. https://uspl.lilly.com/reyvow/reyvow.html#pi 
  3. https://www.reyvow.com/ 

*The contents of this video are intended for general informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD does not recommend or endorse any treatment, products, or procedures mentioned. Reliance on any information provided by this content is solely at your own risk.