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Rethinking Migraine Risks: Are Triptans Safer Than We Thought and CGRP Drugs Less So?
If you live with migraine, you have likely worried about medication safety. Recent attention has focused on the potential risks of the newer migraine drugs, CGRP inhibitors. However, this news should serve as a reminder of the established safety profile of triptans.
For years, many patients have been afraid to take triptans because of fears about "shrinking blood vessels" and heart risks. But a review of current research—including a massive 2025 study—suggests these are very safe drugs. In many countries, including Germany, the UK, and Sweden, they have been sold without a prescription for over a decade.
The New CGRP Data: A "Modest" Signal
When the new class of migraine drugs, CGRP blockers, was introduced, they were touted as safer than triptans regarding strokes or heart attacks. However, a large 2026 study of over 900,000 patients on CGRP inhibitors (such as Aimovig, Nurtec, and Ubrelvy) suggests these drugs may also carry a risk.
The data showed a modestly increased risk of cardiovascular events, specifically ischemic stroke, for those starting these drugs. While the absolute risk remained low, it is important to note that patients starting these drugs often had higher baseline risk factors (like high blood pressure) than those who didn't.
Busting the Triptan Myths
While CGRP inhibitors are under the microscope, we have over three decades of data on triptans (like sumatriptan, naratriptan, and rizatriptan). There is a persistent myth that triptans are dangerous because they work solely by "clamping down" on blood vessels. The science tells a different story.
1. It’s Not Just About Blood Vessels
While triptans do cause minimal constriction of the blood vessels in the meninges (the covering of the brain), their primary therapeutic actions are:
Blocking the release of inflammatory peptides.
Inhibiting pain transmission along the trigeminal nerve.
Quieting the central brain pathways that process pain signals.
2. The "Chest Tightness" Sensation
Many people stop taking triptans because they feel a sensation of tightness or pressure in their neck, jaw, or chest—often called "triptan sensations." While scary, research indicates this is rarely serious and is not typically caused by heart ischemia (lack of blood flow). In studies where patients experienced this tightness, electrocardiograms (ECGs) showed no evidence of heart distress.
The Verdict on Heart Safety
Is the evidence reassuring? Yes. Recent data provides a strong safety argument:
Real-World Evidence: A 2025 study from Israel analyzed over 26,000 migraine patients. They found that triptan usage did not increase the risk of heart attacks or strokes, even in patients who already had cardiovascular risk factors.
Low Absolute Risk: A large study from Denmark noted that for the average person with low background risk, the chance of a serious event was extremely low—estimated at about 1 in 30,000 new users.
Expert Consensus: Clinical reviews confirm that serious cardiovascular events are "extremely low." The safety profile of triptans is considered excellent, and they remain a primary choice for patients without a history of established vascular disease.
The Bottom Line
If you have been avoiding triptans due to fear of heart risks, you might be suffering unnecessarily.
For CGRP Inhibitors: The risk is modest and likely acceptable for most, but warrants a discussion with your doctor if you have existing stroke risk factors.
For Triptans: With 30+ years of data, the evidence suggests they are highly safe for the vast majority. They work on pain pathways, not just blood vessels. For those without active heart disease, the benefits of effective pain relief often far outweigh the theoretical risks.
