Severe migraines are often accompanied by nausea and vomiting, making oral medications ineffective.  Sumatriptan (Imitrex) and Zomig (zolmitriptan) are available in a nasal spray and Imitrex also as an injection (a needleless injection, Sumavel was launched recently).  Nasal spray is not well absorbed and does not work well for many (in my experience, Zomig spray is somewhat better than Imitrex).  Injections work fast, but are painful (even the needleless injection hurts) and expensive.  Another way to get medicine into the body is rectally.  Rectal suppositories are absorbed very quickly and more consistently than nasal sprays.  Europeans are much more receptive to this route of administration than the Americans.  A group of Italian researchers compared  the effect of a suppository containing 25 mg of sumatriptan with a 50 mg tablet.  The suppository was slightly more effective than the tablet.  Imitrex suppositories are not available, but so called compounding pharmacies can prepare a suppository of any medication, if doctor writes an order.  With Imitrex going generic, the price should be more affordable.

There are two other products in development (not yet available), which will bypass oral route – a sumatriptan skin patch and an inhaler of dihydroergotamine (Levadex).  The patch is somewhat large and may be awkward to use, while the inhaler is much more promising.  Inhaling a drug into the lungs provides very fast onset of action, faster than subcutaneous injection of Imitrex.  According to the published data the efficacy of Levadex is very good with few side effects.