Triptans for Migraine

Background

Almost everybody suffers from a headache once in a while, but if the pain is excruciating and disabling, you could have a migraine. Over-the-counter pain relievers are a good first option for knocking out these severe headaches, but if these don’t work, it may be time to reach for a stronger class of medicines called triptans.

Triptans are effective medicines used to treat migraine headaches. They significantly reduce pain within two hours for most people. Complete relief is less common, but if you take a triptan early during a migraine attack you may have a better outcome.

To help you and your doctor choose the right triptan if you need one, Consumer Reports Best Buy Drugs has evaluated the drugs in this category based on their effectiveness, safety, and cost. This brief is a summary of a longer report you can access on the Internet at CRBestBuyDrugs.org. You can also learn about other drugs we’ve analyzed on this free Web site.

Our independent evaluations are based on scientific reviews conducted by the Oregon Health and Science University-based Drug Effectiveness Review Project. Grants from the Engelberg Foundation and the National Library of Medicine help fund Consumer Reports Best Buy Drugs. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Do You Need a Triptan?

Migraines can be misdiagnosed, and some types of migraines should not be treated with triptans. If you suffer from severe headaches or think you might have migraines, you should see a doctor to get an accurate diagnosis and receive the appropriate treatment.

If diagnosed with migraines, first you may want to reach for nonprescription pain relievers, such as acetaminophen (Tylenol and generics), aspirin, ibuprofen (Advil and generics), naproxen (Aleve and generics), or combination products that contain acetaminophen, aspirin, and caffeine (Excedrin Extra Strength, Excedrin Migraine, and generics).

If those don’t work for you, the next step may be a triptan.

Frequency of Triptan Side Effects

Generic Name and Dose (Brand Name)1

Any Adverse Event Experienced1

Chest Pain/Tightness

Dizziness

Numbness + Tingling

Sleepiness

Fatigue

Almotriptan 12.5 mg (Axert)

24%

Less than 1%

Less than 2%

Less than 1%

Less than 1%

Less than 2%

Eletriptan 40 mg (Relpax)

27%

1%-7%

1%-7%

1%-2%

2%-7%

3%-7%

Frovatriptan 2.5 mg (Frova)2

Naratriptan 2.5 mg (Amerge)

23%

2%

2%-5%

1%-4%

2%-5%

Rizatriptan 10 mg (Maxalt)

30%

1%-3%

5%-6%

4%

2%-9%

2%-8%

Sumatriptan 100 mg (Imitrex)

33%

1%-7%

2%-10%

2%-7%

2%-7%

3%-11%

Zolmitriptan 5 mg (Zomig)

40%

Sumatriptan/naproxen 85 mg/500 mg (Treximet)

Less than 2%

3%-5%

2%-3%

3%-4%

Less than 2%

1. Data from a meta-analysis of head-to-head trials, in C. Asseburg, P. Peura, T. Oksanen, J.a Turunen, T. Purmonen and J. Martikainen (2012). Cost-effectiveness of oral triptans for acute migraine: Mixed treatment comparison. International Journal of Technology Assessment in Health Care, 28, pp 382-389. doi:10.1017/S0266462312000517.

2. No head-to-head trials


Bold indicates superiority to sumatriptan 100 mg in high-quality head-to-head comparative studies.

Our Recommendations

Our report considered the evidence for effectiveness, safety, and side effects, as well as cost, and chose one triptan, in several forms, as our Consumer Reports Best Buy Drug:


Generic sumatriptan tablets, nasal spray, and injectable forms


Sumatriptan is available as a less expensive generic, and studies have found that it is as effective as or better than most of the other triptans when it comes to pain relief. At $14 to $17 per tablet, the pill form will save you money over the other brand-name triptans. The generic sumatriptan nasal spray and injectable forms are more expensive, but these may be good options for those who experience nausea and vomiting when they have a migraine, and can’t take a tablet. Another sumatriptan option is the patch formulation, Zecuity, that was approved by the FDA in January 2013, but it is not available as a generic, so it is likely to be expensive.

If sumatriptan doesn’t work for you, we recommend trying rizatriptan (Maxalt and generic). Studies indicate it works very well in delivering pain relief within two hours compared with many of the other triptans. But it might be more expensive than generic sumatriptan tablets.

Overall, the available evidence does not clearly show that one triptan has a superior safety profile or a lower rate of side effects than the others. All of these drugs can cause mild to serious side effects. The most common ones are dizziness, numbness, tingling, flushing, sleepiness, and fatigue. Triptans have been associated with rare cases of heart attacks, life-threatening disturbances of heart rhythm, stroke, and death. Certain people should not take triptans, including those who have coronary artery disease or angina (chest pain) or peripheral vascular disease. People who have had a heart attack or stroke, have uncontrolled high blood pressure, or have migraines that are accompanied by weakness or paralysis in an arm or leg, vertigo, ringing in the ears, or speech difficulties should also avoid triptans.

In addition, triptans should be prescribed with caution for those with risk factors for vascular disease, such as men over 40; women over 55; anyone who smokes, has high cholesterol, diabetes, a family history of early heart disease or stroke; and anyone who is significantly overweight.

Cost Comparison

Generic Name and Dose

Brand Name

Maximum Allowed Dose per 24 Hours

Price per Dose1

Average Monthly Cost1

(If 2 migraines per month and take 1 dose per attack)

Average Monthly Cost1

(If 2 migraines per month and take maximum allowed amount over 24 hours)

Almotriptan tablet 6.25 mg

Axert

25 mg

$34

$67

$269

Almotriptan tablet 12.5 mg

Axert

25 mg

$34

$68

$137

Eletriptan tablet 20 mg

Relpax

80 mg

$38

$76

$303

Eletriptan tablet 40 mg

Relpax

80 mg

$38

$76

$153

Frovatriptan tablet 2.5 mg

Frova

7.5 mg

$42

$83

$249

Naratriptan tablet 1 mg

Generic

5 mg

$24

$48

$239

Naratriptan tablet 2.5 mg

Generic

5 mg

$12

$23

$47

Naratriptan tablet 2.5 mg

Amerge

5 mg

$40

$80

$160

Rizatriptan tablet 5 mg

Generic

30 mg

NA2

NA

NA

Rizatriptan tablet 5 mg

Maxalt

30 mg

$39

$77

$464

Rizatriptan tablet 10 mg

Generic

30 mg

NA2

NA

NA

Rizatriptan tablet 10 mg

Maxalt

30 mg

$44

$87

$262

Rizatriptan dissolvable tablet 5 mg

Generic

30 mg

NA2

NA

NA

Rizatriptan dissolvable tablet 5 mg

Maxalt MLT

30 mg

$39

$79

$473

Rizatriptan dissolvable tablet 10 mg

Generic

30 mg

NA2

NA

NA

Rizatriptan dissolvable tablet 10 mg

Maxalt MLT

30 mg

$46

$91

$274

Sumatriptan nasal spray 5 mg

Generic

40 mg

$38

$76

$610

Sumatriptan nasal spray 5 mg

Imitrex

40 mg

$50

$101

$805

Sumatriptan nasal spray 20 mg

Generic

40 mg

$38

$76

$153

Sumatriptan nasal spray 20 mg

Imitrex

40 mg

$48

$95

$191

Sumatriptan tablet 25 mg

Generic

200 mg

$17

$34

$276

Sumatriptan tablet 25 mg

Imitrex

200 mg

$38

$75

$600

Sumatriptan tablet 50 mg

Generic

200 mg

$15

$30

$119

Sumatriptan tablet 50 mg

Imitrex

200 mg

$39

$78

$312

Sumatriptan tablet 100 mg

Generic

200 mg

$14

$28

$55

Sumatriptan tablet 100 mg

Imitrex

200 mg

$41

$82

$163

Sumatriptan cartridge injectable 4 mg/0.5 mL

Generic

12 mg

$54

$109

$327

Sumatriptan cartridge injectable 6 mg/0.5 mL

Generic

12 mg

$47

$94

$188

Sumatriptan cartridge injectable 6 mg/0.5 mL

Imitrex

12 mg

$120

$240

$479

Sumatriptan pen injectable 4 mg/0.5 mL

Generic

12 mg

$49

$97

$291

Sumatriptan pen injectable 6 mg/0.5 mL

Generic

12 mg

$50

$100

$200

Sumatriptan pen injectable kit 6 mg/0.5 mL

Alsuma

12 mg

$55

$110

$219

Sumatriptan pen injectable 6 mg/0.5 mL

Imitrex

12 mg

$66

$133

$266

Sumatriptan needleless injectable 6 mg/0.5 mL

Sumavel DosePro

12 mg

$65

$130

$260

Sumatriptan vials injectable 6 mg/0.5 mL

Generic

12 mg

$39

$78

$156

Sumatriptan patch 6.5 mg/4 hours

Zecuity

12 mg

NA2

NA

NA

Zolmitriptan tablet 2.5 mg

Zomig

10 mg

$41

$81

$326

Zolmitriptan tablet 5 mg

Zomig

10 mg

$45

$91

$182

Zolmitriptan dissolvable tablet 2.5 mg

Zomig ZMT

10 mg

$39

$77

$309

Zolmitriptan dissolvable tablet 5 mg

Zomig ZMT

10 mg

$45

$91

$182

Zolmitriptan nasal spray 5 mg

Zomig

10 mg

$48

$96

$192

Fixed-Dose Combination Product

Sumatriptan/naproxen sodium
85 mg/500 mg

Treximet

170 mg/1,000 mg

$31

$61

$122

1. Prices per dose and monthly costs are derived from national average retail costs for December 2012 rounded to the nearest dollar. Information is derived by Consumer Reports Best Buy Drugs from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.

2. NA = Price data not available.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health care professional. Consumers Union is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, non-commercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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