Triptans

Triptans are a family of tryptamine-based drugs used as abortive medication in the treatment of migraines and cluster headaches. This drug class was first introduced in the 1990s. While effective at treating individual headaches, they do not provide preventive treatment and are not considered a cure. They are not effective for the treatment of tension–type headache, except in persons who also experience migraines. They may be effective in disabling tension–type headaches, which exist on a spectrum of migraine. Triptans do not relieve other kinds of pain. Triptans are a family of tryptamine-based drugs used as abortive medication in the treatment of migraines and cluster headaches. This drug class was first introduced in the 1990s. While effective at treating individual headaches, they do not provide preventive treatment and are not considered a cure. They are not effective for the treatment of tension–type headache, except in persons who also experience migraines. They may be effective in disabling tension–type headaches, which exist on a spectrum of migraine. Triptans do not relieve other kinds of pain. The drugs of this class act as agonists for serotonin 5-HT1B and 5-HT1D receptors at blood vessels and nerve endings in the brain. The first clinically available triptan was sumatriptan, which has been marketed since 1991. Triptans have largely replaced ergotamines, an older class of medications used to relieve migraine and cluster headaches. Triptans are used for the treatment of severe migraine attacks or those that do not respond to NSAIDs or other over-the-counter drugs. Triptans are a mid-line treatment suitable for many migraineurs with typical attacks. They may not work for atypical or unusually severe migraine attacks, transformed migraine, or status (continuous) migrainosus. Triptans are highly effective, reducing the symptoms or aborting the attack within 30 to 90 minutes in 70–80% of patients. A test measuring a person's skin sensitivity during a migraine may indicate whether the individual will respond to treatment with triptans. Triptans are most effective in those with no skin sensitivity; with skin sensitivity, it is best to take triptans within twenty minutes of the headache's onset. Oral rizatriptan and nasal zolmitriptan are the most used triptans for migraines in children. Triptans are effective for the treatment of cluster headache. This has been demonstrated for subcutaneous sumatriptan and intranasal zolmitriptan, the former of which is more effective according to a 2013 Cochrane review. Tablets were not considered appropriate in this review. A single randomized controlled trial found that sumatriptan may be able to prevent altitude sickness. All marketed triptans are available in oral form; some in form of sublingual tablets. Sumatriptan and zolmitriptan are also available as nasal sprays. For sumatriptan, a number of other application forms are marketed: suppositories, a subcutaneous injection, a iontophoretic transdermal patch, which uses low voltage controlled by a pre-programmed microchip to deliver a single dose of sumatriptan through the skin within 30 minutes; a drug-device combination containing sumatriptan powder that is 'breath powered' allowing the user to blow sumatriptan powder in to their nostrils; as well as a needle-free injection system that works with air pressure.