More on daily intake of triptans (sumatriptan or Imitrex and other similar drugs)

“Daily triptan use for intractable migraine” is the title of a report by Dr. Egilius Spierings published in the latest issue of the journal Headache. This is a controversial topic, which I addressed in a previous post. Dr. Spierings, who is affiliated with both Tufts Medical Center and Harvard Medical School presents a case of a 50-year-old woman who failed trials of multiple preventive medications. This woman responded well to sumatriptan, 100 mg, which she took daily and occasionally twice a day with excellent relief and no side effects. Dr. Spierings discusses the evidence for Medication Overuse Headaches (MOH), which is common with caffeine-containing drugs, butalbital (a barbiturate), and opioid drugs (narcotics). It is less clear whether triptans cause MOH and he mentions that most patients who end up taking a daily triptan do so only after they failed many preventive (prophylactic) drugs and after they discover that they can have a normal life if they take a triptan daily. This applies not only to sumatriptan, but any other similar drug, such as Amerge (naratriptan), Zomig (zolmitriptan), Maxalt (rizatriptan), Relpax (eletriptan), and other. After 20 years of being on the market, we have no evidence that these drugs have any long-term side effects. In Europe several of these drugs are sold without a prescription. The major obstacle to their daily use has been the cost. However, several of these medications are now available in a generic form and a 100 mg sumatriptan tablet costs as little as $1.50.

5 comments
  1. Dr. Mauskop says: 02/20/20149:08 am

    Triptans rarely cause medication overuse headaches. If you suffer from frequent or chronic migraines it is better to try to find a preventive medication or get Botox injections, but if all else fails, taking a triptan daily is an effective and safe option for some.

  2. Tara Herrin says: 02/19/201411:54 pm

    My neuro says not to take triptans more than 3 days a week. I have chronic daily headaches. Do they cause MOH if taken more often?

  3. Dr. Mauskop says: 02/06/201411:15 pm

    Yes, antidepressants such as venlafaxin (Effexor), desvenlafaxine (Pristiq), and a similar drug, duloxetine (Cymbalta) can all be helpful. John is also right about some patients needing a high dose. Like all drugs, these also have potential side effects and at times they are difficult to stop because of withdrawal symptoms. These three antidepressants belong to the family of SNRIs (serotonin norepinephrine reuptake inhibitors). Another type of antidepressants, SSRIs (selective serotonin reuptake inhibitors) such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and other do not relieve headaches or other types of pain. An older type of antidepressants, so called tricyclics, such as Elavil (amitriptyline), nortriptyline (Pamelor), ad other are also very effective, but in some people cause more side effects than SNRIs.

  4. John Bedson says: 02/06/201411:07 pm

    Tim: If triptans work on your, Anti-depressants should work on you. Try Venlafaxine. Or Pristiq.

    But you may need a high dose. Often these doctors use too low dose of antidepressants on migraine and it is little wonder that they don’t work. If Venlafaxine or Pristiq don’t work, throw in some Topamax to go with it at the same time.

  5. Tim says: 02/05/201410:39 am

    My migraines and I have been under the care of a Neurologist (who sees only migraine patients) in Rochester NY for 6+ years. After trying approximately 9 separate preventatives (from Topamax, Zonegran, Atenolol, Mirtazapine, Nortriptyline to name a few), and a half dozen rounds of Botox, my doctor has mentioned several times (reinforced by his determination to see that his patients have all the prescriptions of triptans they need) that he also has seen no evidence of negative health effects of daily triptan use. He even referred me to some supporting evidence: http://www.ncbi.nlm.nih.gov/pubmed/12752754

    My quality of life is immeasurably better with the prescriptions (Imitrex and Amerge) that I take every night. The dread about how I will feel the next day, as in anticipating a migraine, is gone, and I have reduced from 20+ migraines a month, to less then 4. And those migraines respond to medication, as long as I am conscientious about not mixing or dosing beyond what can safely be taken.

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