Symptoms of migraines

A migraine headache will usually have several of the following features:

• Typically throbbing and severe.
• Usually at the front of the head.
• Usually localised to one side of the head but not always.
• Nausea, queasiness, vomiting.
• Intolerance of bright light (photophobia).
• Other heightened sensitivities, e.g. to noise and strong smells.
• A sufferer will often need to avoid normal activities.
• Usually last a few hours but can last up to 3 days.
• Aura - a migraine may start with symptoms such as flashing lights, seeing zigzag lines, blurring, having a blind spot. Other sensory aura may include tingling sensations, problems with co-ordination and concentration, speech difficulty, and blackouts (rare).
• After the migraine headache has gone, tiredness and 'washed out' feelings are common and can last several days.
• Symptom free between headaches.

Migraine is common affecting about 1 in 4 women and 1 in 12 men in the UK.

• A quarter of people who get migraine have a warning or aura before their headaches.
• It is unusual for migraine to first start after the age of 40.
• Some women get migraine around the time of their periods.
• Migraine attacks can be triggered by stress, tiredness, and some medication. In some cases trigger foods can be identified.

'Triptans'

Triptan medication is for people under 65, who have been diagnosed with migraine, not for other types of headaches.

Migraine headaches are linked to swelling and leakage of blood vessels in and around the brain. Triptans (5HT₁-receptor agonists) work by reversing this expansion of blood vessels.

The original and most widely used 'triptan' is Imigran, which is a brand name for the drug sumatriptan. Newer alternatives have also been developed including almotriptan (Almogran), eletriptan (Relpax), frovatriptan (Migard), naratriptan (Naramig), rizatriptan (Maxalt), and zolmitriptan (Zomig).

We supplies a choice of triptan medication and formulations including tablets, melt-in-the-mouth tablets, and nasal sprays. Strict order limits are enforced (maximum 12 tablets or sprays).

If your first choice of triptan does not work, alternative triptans are worth trying. You must leave at least 24 hours between taking different triptans.

Do NOT mix different types of triptans for the same headache episode.

Triptans are not licensed for use by those aged over 65.

Other treatments for acute migraine

Once a migraine has started, rest and taking medication is usually the quickest way to settle the symptoms.

In many cases, people find simple anti-inflammatory tablets such as ibuprofen (400mg to 600mg), or aspirin (900mg) are effective on their own without needing to use a triptan medicine.

Caution: anti-inflammatory painkillers and aspirin can be associated with acid indigestion and even intestinal bleeding.

Anti-sickness tablets if taken early can also help. They can aid absorption of the anti-migraine medication as well as reducing symptoms of nausea.

People experiencing frequent migraines may benefit from preventative treatments. If suffering more than one migraine per week, see your GP to discuss preventative treatment.

Cautions

Triptans have been used by millions of people throughout the world for decades and are generally considered safe drugs.

Triptans can cause a temporary narrowing of all blood vessels. People should not take triptans if they have had:

• Strokes or mini-strokes (TIAs).
• Problems with poor circulation.
• Angina (heart pain on exertion).
• Heart attack.
• Irregular heart rhythm.

Even in people who have never had circulation problems triptans can, in rare situations, trigger serious heart problems. To reduce this risk, the following groups should check with a GP before taking triptan medication:

• Heavy smokers (over 25 cigarettes/day) or have been a heavy smoker in the past.
• Men over 40.
• Women after the menopause.

In some rare serious cases migraine headaches are associated with temporary paralysis, loss of vision, and loss of speech. Triptans are not to be used in these cases.

If triptans and other painkillers are used too frequently they can actually cause headaches, often called medication overuse headaches.

There are some medications which should not be taken at the same time as triptans. Checks are carried out in the online consultation and full details are in manufacturers' patient information leaflets (see links below) supplied with your medication.

Side effects of triptans

All medications have the potential to cause unwanted side effects but not everyone gets them. When taking triptan migraine therapies, it can sometimes be hard to tell if a symptom is from the migraine itself or is a side effect. There is no major difference between the different triptans and their side effects.

The following are commonly reported (may affect up to 1 in 10 people) when taking triptans:

• Headache.
• Dizziness, sleepiness, and tiredness.
• Aching or weak muscles.
• Abnormal sensations such as tingling, numbness, hot or cold flushes, over sensitive/less sensitive skin - these can be intense but generally pass quickly.
• Feeling sick (nausea), dry mouth, throat discomfort, vomiting, diarrhoea, indigestion.
• Palpitation.

More serious but rare side effects can include:

• Heavy, pressure, tight feelings or pain/discomfort in the throat, neck, arms, and chest. If these occur stop using the medication. If they do not settle within 15-20 minutes or become very severe, get emergency medical help - telephone 999 in the UK. In a very small number of susceptible people triptans can trigger angina or a heart attack.
• In rare cases there is an allergy to triptans, leading to skin rash. The signs of serious allergy can include rash, hives, wheezing, swollen eyelids, face or lips, followed by complete collapse. If this develops, get emergency medical help straight away - telephone 999 in the UK.

For a full list of side effects and cautions see the Patient Information Leaflet included with medicine packs (links below).

Preparations of sumatriptan (Imigran)

Sumatriptan is available as tablets and as a nasal spray.

Some people find the nasal spray works more quickly and is easier to take when they are feeling nauseated (sick).

Dosage for sumatriptan

Tablets (50mg and 100mg): Take 50mg (some patients may require 100mg) at onset of symptoms, dose may be repeated after at least 2 hours if migraine symptoms return. Maximum dose is 300mg in 24 hours.

Nasal spray (10mg and 20mg): Use 1-2 sprays (10mg-20mg) into one nostril at onset of symptoms, dose may be repeated once after at least 2 hours if migraine symptoms return. Maximum dose in 24 hours is 40mg.

Sumatriptan should not be taken with other 'triptans' or with medication containing ergotamine.

Sumatriptan patient information leaflets

• Sumatriptan tablets (50mg & 100mg)
• Imigran Nasal Spray (10mg & 20mg)

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Preparations of rizatriptan (Maxalt)

Rizatriptan (10mg) is available from us as the brand name Maxalt or generic rizatriptan tablets and as Maxalt Melts or orodispersible tablets which dissolve in the mouth.

Migraine can often cause nausea and vomiting so swallowing tablets may not work. In those cases the melt-in-the-mouth tablets may be better.

Dosage for rizatriptan

Take one 10mg tablet as soon as possible after the headache begins. It should not be repeated for the same headache within 2 hours but can be repeated after 2 hours if the headache returns. Maximum of two doses in 24 hours.

Preparations of zolmitriptan (Zomig)

Zolmitriptan (2.5mg and 5mg) is available from us as tablets, and as tablets which dissolve in the mouth (orodispersible). Tablets are available as the original brand Zomig, or as generic zolmitritpan.

Zolmitriptan is also available as Zomig Nasal Spray 5mg.

Orodispersible tablets and nasal spray may be better if feeling sick (nausea). The nasal spray tends to work more quickly.

Dosage for zolmitriptan tablets

The dose for all the tablets is the same. Start with taking one Zomig/zolmitriptan 2.5mg tablet or 2.5mg orodispersible tablet or Rapimelt.

Either swallow the tablet whole with a drink of water or allow the orodispersible tablet or Rapimelt to dissolve on the tongue. They can be taken with or without food. Symptoms should improve within an hour.

If some headache persists after 2 hours, or it comes back within 24 hours, then a second 2.5mg tablet can be taken. Do not take Zomig/zolmitriptan more than twice in 24 hours.

If the 2.5mg dose does not manage to clear the migraine completely, then 5mg tablets can be used in future attacks. Side effects are more likely if taking the higher dose.

Dosage for zolmitriptan nasal spray

The nasal spray contains 5mg zolmitriptan in a single dose spray. Use one spray in one nostril only. The headache should begin to improve within 15 minutes.

If there is still some headache 2 hours later, then another single dose of 5mg nasal spray can be taken. Do not take Zomig/zolmitriptan more than twice in 24 hours.

The maximum dose of any form of Zomig/zolmitriptan in 24 hours is 10mg (2 x 5mg) in total.

When to see a GP

• Before self medicating for migraine headaches it is best to see a GP for a diagnosis.
• Very sudden onset of very severe headache, sometimes called 'thunderclap' headache.
• When headaches start for the first time over the age of 40.
• When headaches are getting more frequent and lasting longer.
• If headaches are worsening after taking triptans for over 10 days or other pain killers for over 15 days. Your doctor may recommend stopping treatment for a month, as this could be medication overuse headache/withdrawal headache.
• When headaches are different from before (new symptoms).
• If there are new headaches and other signs of being generally unwell, e.g. unintentional weight loss, neurological symptoms, eye symptoms.
• People who experience two or more attacks a month which cause disability, or who are not responding to treatment, should also consult their GP.
• If you develop a new severe headache in pregnancy.