Another study confirms vascular safety of triptans
Sumatriptan (Imitrex) and other triptans have been available without a prescription in all European countries for over a decade. A new study by Austrian researchers published in the current issue of Headache confirms the outstanding safety of these drugs.
The study looked at 13,833 people over 50 years of age who were prescribed a triptan in 2011, the year before triptans became available over-the-counter. The comparison group included 41,400 triptan non-users. Of the 13,833, 19% were older than 65. The researchers established that 16% “overused” triptans, defined as getting more than 30 doses in a 90-day period, although the concept of “overuse” clearly lacks a scientific basis.
They discovered that those who were taking triptans did not spend more time in a hospital. They also did not have a higher frequency of heart attacks, hypertension, irregular heartbeats (arrhythmias), strokes, circulation problems in their extremities, or other vascular problems. This was true even for those who “overused” triptans.
These findings are consistent with the “Consensus Statement: Cardiovascular Safety Profile of Triptans in the Acute Treatment of Migraine” by the Triptan Cardiovascular Safety Expert Panel published in 2004. It states “The incidence of serious cardiovascular events with triptans in clinical trials and clinical practice appears to be extremely low “.
Unfortunately, in the US triptans are available only by prescription. About 15 years ago, the FDA blocked an application by the American Home Products (a company that Pfizer later acquired) to launch over-the-counter sumatriptan. This greatly restricts access to a highly effective and safe migraine drug. Many physicians remain under the impression that triptans cause heart attacks, strokes, and other dangerous side effects. My patients often tell me that this is what their previous doctor warned them about.
It is clear that triptans are safer than Excedrin, aspirin, ibuprofen, or naproxen. Several dozen of my patients have been taking triptans daily for years. They do not have medication overuse headaches, do not suffer any long-term side effects, and do enjoy disability-free life.
Withdrawal symptoms from stopping triptans are rare. The most common withdrawal symptom, if the triptan was helping, is that the headaches might worsen. Consult your doctor to manage nausea, insomnia, or whatever else bothers you.
I have heard that you can experience withdrawal symptoms from just stopping triptans. Best meds to cope with the pain, nausea and insomnia?
Triptans do not require weaning off. If headaches stop, triptans can be stopped.
I have been taking triptans 1-2x daily for 5 months. If my migraines start to improve, what is the best way to wean off of triptans so I don’t experience any side effects? Thank you.
You may want to read my book, The End of Migraines: 150 Ways to Stop Your Pain to find the answers.
Hi Dr. Mauskop. I am wondering if there is any good evidence that anti-anxiety medication helps prevent migraines? I have recently read about Gepants for prevention of migraines. What are your thoughts on them, the best one to take and how long they take to start working? Thank you!
Thanks Dr. Mauskop, this is very reassuring. Please keep posting your findings to your blog, they are so helpful for those of us struggling with chronic migraines.
Botox is a safer option than CGRP or any other drug. And it is at least as effective, if not more.
Hi Dr. Mauskop, after almost a month of no migraines because of daily eletriptan taken every night, my migraines returned due to extreme barometric pressure and temperature changes. I started to time the taking of eletriptan to an hour or so before the pressure changed (using a pressure tracking app). This method prevented most of the migraine pain, but not all of the prodrome or brain fog symptoms. Last week I found out that my doctor would not continue prescribing enough triptans to last me throughout the month, so I pleaded with my pharmacist to allow me 12 more tabs. The barometric pressure and temps continue to fluctuate greatly, so I am desperate to find a new treatment plan. I have actually found a new family doctor very quickly and hope to be referred to a neurologist. I will discuss the safety of daily triptans with them, but if they suggest taking a new preventive, would you recommend Botox over CGRP mAbs, along with eletriptan? I have tried other preventives with no success and am wary of topamax because of the kidney stone risk (due to family history). I am 50 and perimenopausal and have read that CGRP mAbs may not be the right choice. Thanks Dr. Mauskop!
I’ve taken maxalt for 10 years. It’s like magic how it stops weekly migraines in their tracks.
Hello Dr. Mauskop, I’m very happy to report that I’m going on day 10 of no migraines after starting daily triptans and being reassured by your posts about their safety and comments from other migraine sufferers who do the same thing, Going this long with no pain or migraine symptoms is unheard of for me in recent years. I have the interim support of my pharmacist and will be talking with my doctor this week. Is there an article that you recommend on the mechanism of triptans? Everything I can find mentions vasoconstriction, but I know this is not the whole story. If you have any good resources to share, I would be most grateful. And Happy New Year!
Thanks for your reply, Dr. Mauskop, and how amazing it would be if this research confirms the safety of daily triptan use! I am preparing to talk to my doctor and pharmacist about daily use, and I want to make sure I have all my facts straight. The medical consensus seems to be that triptans relieve migraine pain through vasoconstriction (as agonists of serotonin receptors at blood vessels and nerve endings in the brain). I saw in another post here that this is not exactly how they work. Can you please explain how they work or provide a good resource with this info? Many thanks for your help!
Thank you for your comment. I was not aware of this study. I doubt that triptans will ever be officially approved for weight loss since the amount of weight lost was not very impressive. We have much more effective weight loss medications such as semaglutide. But it is good to know that triptans do not cause weight gain which is a common side effect of many migraine medications. These studies may also confirm the long-term safety of the daily use of triptans.
Thank you Dr. Mauskop! Have you heard how the daily use of triptans is being studied for effectiveness in weight loss? (https://www.utsouthwestern.edu/newsroom/articles/year-2022/july-migraine-drug-in-weight-loss.html) This research is in early stages, but if triptans are being considered for daily use for weight loss because of their safety, then surely they can be approved for daily use for migraine patients, some of whom have suffered for decades while trying other treatments. I wish I had seen your blog earlier this year! Best wishes to you for 2023.
Glad to hear my blog was helpful. Hopefully, your doctor will cooperate.
Dear Dr. Mauskop, thank you for this post, I am so glad to have found it. I have been suffering from migraines for all of my adult life, and they became chronic in the last 3-5 years. I have noticed with recent extremes in weather due to climate change and the effects of the polar vortex in North America, that they get worse with all the major changes in barometric pressure, dew point, and temperature. Last week I woke up with piercing head pain and nausea over several days. I took eletriptan and an antiemetic right away, which cleared up the head pain and nausea but not the subsequent brain fog and fatigue (which can last for many hours). I have taken eletriptan abortively for years, but just a few days ago decided to try taking it before bed, to see if they would prevent weather-related migraines the next day (like the ones last week). Three days later, I haven’t had one migraine, my head feels clear and there is no fatigue. This is life-changing for me. All I have heard and read from doctors and the medical literature is that 1) triptans could cause stroke (I heard this soon after Imitrex was available decades ago), 2) triptan overuse can cause rebound migraines, 3) frequent triptan use could lead to other cardiovascular problems, and 4) triptans cannot prevent migraines; they only stop them once they have started. From what you’ve said and from other safety-related articles I have found, I do not believe any of this to be true. I will talk to my doctor and pharmacist soon about gaining their support for taking eletriptan daily. What would you recommend for women 50 or over (whose estrogen and serotonin levels are low) who do not have cardiac conditions themselves, are taking anti-anxiety medication, and have a family history of heart problems? I am so grateful to have found your blog. Thanks for any help you can provide.
Thank you, Dr. Mauskop, for this informative post. I have been using (and often “over-using”) triptans for more than 10 years with zero problems. Triptans have allowed me to continue working and functioning even while living with chronic migraine. I am continually amazed at the number of friends who continue to suffer with migraine pain because their doctors have never recommended a triptan. Those who do know about triptans are often afraid to take them. It’s almost like they think that something that is so effective must come with dangerous side effects. As you’ve said frequently, this is clearly not the case. Triptans have been a miracle drug for me. Please continue writing about their effectiveness and excellent safety profile.