Common Triptan Mistakes: Why Your Acute Migraine Treatment Might Not Be Working

Triptans have been a go-to acute migraine treatment for decades, and for many people these tried-and-true medications reliably keep full-blown migraine attacks at bay.

But that’s not the case for everyone: Some people with migraine still get headaches or only partial pain relief after taking a dose. For many triptan users, the issue may not be with the drug itself, but rather how you’re taking it, when you’re taking it, the type of migraine you have, or what’s happening in your body during the attack.

Here’s what you need to know about common triptan mistakes and expert tips on how to get the most out of every dose.

Triptans are medications used to treat migraine attacks after they’ve started. They’re typically referred to as “acute” or “abortive” medications.

“That means they should be taken at the first symptom of a migraine,” says Ashley Holdridge, DO, a neurologist at Aurora Health Care in Whitefish Bay, Wisconsin.

The goal is to reduce, if not eliminate, migraine pain within two hours and to get back to normal functioning, says Dr. Holdridge.

Available triptans include:

• sumatriptan (Imitrex, Tosymra, others)
• rizatriptan (Maxalt)
• zolmitriptan (Zomig)
• naratriptan (Amerge)
• almotriptan
• eletriptan (Relpax)
• frovatriptan (Frova)

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If your triptan isn’t working as well as you’d hoped, it may not be the medication itself. A few common factors — including timing, dose, and how your body absorbs the drug — can all affect its effectiveness.

Timing

When triptans don’t work well, timing is often a big part of the problem, says Holdridge.

“Taking the medication early gives it the best chance to interrupt the migraine process before the attack fully builds,” she says.

If you’re in the habit of holding off on taking your triptan to find out how severe an attack might be, you’re probably waiting too long. “Waiting too long will make it ineffective for that day’s migraine,” says Dharti Dua, MD, a neurologist who specializes in treating headache and migraine at The Ohio State University Wexner Medical Center in Columbus.

Too Low of a Dose

Dosing errors are another common issue, and one that often happens unintentionally. Some people are prescribed a dose that may need adjustment, while others reduce the dose on their own by splitting pills to make their monthly supply last longer, says Dr. Dua.

That strategy can backfire. “Taking less than the prescribed dose may not fully stop the migraine, which increases the likelihood that symptoms return later the same day or the next,” says Holdridge.

Gastric Stasis or Vomiting During an Attack

For some people, the issue is not timing or dose but the way the medication is getting into the body.

For people experiencing gastric stasis, an injectable triptan or a nasal spray may be an effective option, says Holdridge. “An injectable is by far the fastest-acting formulation, followed by a nasal spray,” she says.

These options can be especially helpful for people whose migraine attacks escalate quickly or who experience nausea and vomiting early in an attack, says Holdridge.

That’s a real issue for some people: Vomiting can prevent an oral medication from being absorbed at all, says Dua.

Wrong Drug for You

Even when triptans are taken correctly, the specific drug may not be the best fit.

“Sometimes people who don’t get effective relief from one triptan will respond to another triptan or another formulation of triptan,” says Dua.

Some migraine patterns can also influence which triptan is a better match. Menstrual migraine, for example, often responds better to frovatriptan or naratriptan, she says. These drugs can be used in a prophylactic manner if the migraine attacks are predictable during this time.

If a triptan isn’t working, the first step is often not abandoning the drug class but taking a closer look at how it’s being used.

Dua and Holdridge offer the following best practices:

• Because triptans work best early in the attack before the migraine has fully ramped up, always have a dose nearby. “My favorite advice is to carry your migraine rescue meds in a keychain pill holder, as migraines are unpredictable,” Dua says.
• Check in with your doctor about your dose; you may need a higher dose for adequate relief. If you’ve been splitting pills to save money, talk with your provider or pharmacist about any available savings programs offered by the manufacturer or if there are any generic options.
• Changing the form of the medication can also help. For people with slowed digestion, vomiting, or very-rapid-onset attacks, non-oral options such as nasal sprays or injections may be more reliable because they bypass the digestive system.
• Trying a different triptan could be the solution; differences in onset, duration, and delivery route can matter.
• Combining a triptan with another medication may help. If you notice a pattern where one triptan dose isn’t enough and a second dose is usually needed, taking a triptan with a nonsteroidal anti-inflammatory drug (NSAID) at the start of the migraine attack can be a helpful strategy, especially for severe attacks.

If changing how you take triptan, when you take it, and which one still isn’t providing adequate relief, it may be time to talk to your doctor about trying a different class of acute migraine medications. A newer medication class known as gepants may be an alternative if triptans are not working or are causing too many side effects.

Because there is a fine line between treating a migraine attack early and starting to use too many abortives, it’s important to speak with your provider about the guidelines on how much to use.

“Frequent need for rescue medications may be a sign that a preventive treatment plan should be part of the conversation,” says Dua.

Ideally, preventive treatment will decrease the frequency, severity, and duration of migraine attacks, as well as reduce the number of days rescue medication is needed, says Holdridge.

“People who are having more than six headache-days per month should discuss their headaches with their primary care provider or neurologist and should look into starting migraine preventive medication,” she says.

• If your triptan isn’t working well, the problem may be timing, dose, or absorption, or simply that a different triptan or formulation would suit you better.
• Taking a triptan early and at the full prescribed dose can improve the odds that it stops the migraine attack before it fully develops.
• Nasal sprays or injections may work better than pills for people with vomiting, slowed digestion during attacks, or very-fast-onset migraines.
• Using triptans too often can lead to medication overuse headache. If you have more than six headache-days per month, talk with your doctor about preventive options.