Is sumatriptan a habit-forming narcotic?

Migraine headaches can put a damper on your life. They’re not just regular old headaches. They can be debilitating, and for some, migraine attacks can mean you lock yourself away in a dark room, missing work, life, and any normal social interactions. Even on days when you pull up your socks and power through, it can be hard to function when you feel nauseous, dizzy, or weak (Friedman, 2016). On days like these, some people find that certain prescription medications can really help.

Sumatriptan is one of the most commonly prescribed medications for migraines and cluster headaches, and research shows that it’s effective (Smith, 2020).

If you’re taking sumatriptan for the first time, you may have questions about its safety and whether it’s addictive. Sumatriptan isn’t a habit-forming narcotic, but it is possible to overuse migraine medications (Diener, 2004). 

One result is a medication overuse headache (MOH) or “rebound headache” (Diener, 2004). Another, more serious result could be serotonin syndrome, which can be fatal if untreated (Heller, 2018). Read on to learn how sumatriptan works and how to use it safely. 

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The short answer is no. Sumatriptan (brand name Imitrex) is a triptan, one of a group of drugs that includes almotriptan, zolmitriptan, frovatriptan, rizatriptan, naratriptan, eletriptan, and of course, sumatriptan (Smith, 2020). Narcotics are another group of drugs entirely, called opioids. Opioids are pain relievers like codeine, fentanyl, oxycodone, tramadol, and morphine and can be habit-forming (Vorvick, 2019). While sumatriptan is used to alleviate the pain of migraine headaches, it’s not a general pain reliever. It won’t alleviate the pain of a sprained ankle, for example, or menstrual cramps, and it won’t get you “high.” 

Doctors may prescribe narcotics to relieve migraines, but only if other treatments haven’t worked. Narcotics can be addictive, and they are often not more effective than aspirin in relieving migraines. Healthcare providers will normally try other treatment options first and prescribe narcotics only when other treatments fail (Worthington, 2013). 

And while sumatriptan is not a narcotic, it’s still possible to take too much. Taking too much sumatriptan or other migraine medication can lead to medication overuse headache (MOH), or “rebound headache” (Diener, 2004). 

A medication overuse headache (MOH) is a headache caused by using too much medication—specifically pain medication. Interestingly, it’s not something that happens to people who use pain relievers for other conditions like arthritis—it’s specific to people who have a headache disorder (Kristofferson, 2014). You’ll know you have it if you have had a headache for at least 15 days a month for three months running and if your headaches get worse while using migraine medication (AMF, 2016). 

The last thing you want from your migraine medication is another headache. The Imitrex label advises limiting using migraine medications to 10 times a month (FDA, 2013). This includes sumatriptan (or other triptans), ergotamines (like cafergot, ergomar, wigraine), dihydroergotamine (like Migrenal), and other ergot-type drugs, or opioids (like codeine or oxycodone) or any combination of these (NIH, 2015). You can also get MOH from overuse of over the counter pain relievers like acetaminophen (Friedman, 2016).

While medication overuse headaches are certainly something you want to avoid, there’s an even more pressing reason not to overuse migraine medications: serotonin syndrome. 

Serotonin is a naturally occurring chemical in our bodies. It passes signals from our brain cells and between the brain and the rest of our body. Sumatriptan and many other drugs work by acting like serotonin or affecting our body’s serotonin levels. Taking too many of any one of these medications or combining them can cause serotonin syndrome, which can be fatal if not treated (Heller, 2018). 

Signs of serotonin syndrome include high blood pressure, a fast heartbeat, sweating, fever, and diarrhea. Other symptoms include muscle spasms, tremors or shivering, abnormal eye movements, and lack of coordination. Serotonin syndrome also can make you feel anxious, disoriented or confused, restless, or even cause hallucinations (Heller, 2018). These symptoms will usually occur within minutes or hours of taking sumatriptan or starting a newly increased dosage (FDA, 2013). If you experience any of these symptoms, stop taking sumatriptan immediately, and seek emergency medical attention. 

To avoid serotonin syndrome, do not take more than your prescribed dose of sumatriptan. Also, speak to your healthcare provider to receive instruction on how much to take if you are taking any of the following medications, which are often prescribed for depression or Parkinson’s disease:

• SSRIs (selective serotonin reuptake inhibitors) like Celexa, Zoloft (see Important Safety Information), and Prozac (see Important Safety Information)

• SNRIs (selective serotonin/norepinephrine reuptake inhibitors) like Cymbalta (see Important Safety Information) and Effexor (see Important Safety Information) (Heller, 2018). You should not take sumatriptan within 24 hours of taking these drugs (FDA, 2013). 

• MAO inhibitors (monoamine oxidase inhibitors) like Nardil (NIH, 2015). You should not take sumatriptan within two weeks of using an MAO inhibitor (FDA, 2013).

Sumatriptan is one of the most commonly prescribed migraine medications, and research shows that it works (Derry, 2014). However, researchers are still not exactly sure how migraines and migraine medications work. But we do know a few important things. 

We know a migraine headache happens when a trigger turns “on” pain signals. Triggers differ from person to person but commonly reported triggers include stress, lack of sleep, hormonal changes (like getting your period), or even food, alcohol, or certain smells (Friedman, 2016). 

We also know that sumatriptan is migraine-specific (Smith, 2020). It stops a migraine headache in action and prevents it from getting worse (Ahn, 2005). That’s why it works best when used as early as possible—as soon as the pain begins. Unfortunately, it doesn’t work to prevent migraine attacks from happening and can’t be used to prevent them (Worthington, 2013). 

Now you know only to take sumatriptan after your migraine starts and that it is possible to take too much. So how much should you take? Imitrex is a prescription medication and should be taken according to the instructions provided by your healthcare provider or pharmacist. 

Sumatriptan dosage depends on how you take it. It is available as a tablet, nasal spray, or injection. It’s also available in a tablet that combines sumatriptan with the pain reliever naproxen (brand name Treximet). Here are a few basics on each format.

Oral sumatriptan tablets (Smith, 2020: 

• Available in 25 mg, 50 mg, or 100 mg doses.  

• 100 mg doses work best, but 50 mg doses can balance effectiveness with reduced side effects.

• The maximum dose in a 24 hour period is 200 mg.

• Problematic for patients who become nauseous and vomit, especially early in the migraine

Nasal sumatriptan:

• Available as liquid, spray, or powder, inhaled through the nose. (Smith, 2020)

• Dosages vary, depending on the exact medication. Ask your healthcare provider for directions. (Smith, 2020)

• Works in as few as 15 minutes (Negro, 2018)

• Is more effective and faster acting than oral sumatriptan tablets (Worthington, 2013)

Sumatriptan injections:

• These injections are administered right under your skin. 

• The fastest and most effective form of sumatriptan. It can relieve a migraine headache in just ten minutes (Perry, 1998).

• Available in 3 mg, 4 mg, or 6 mg doses. The maximum dose in a 24 hour period is 12 mg, but the starting dose is typically lower (Smith, 2020).

• Available in two self-injection formats—needle-based and needle-free (which uses compressed gas to push the medication under the skin) (Rothrock, 2010).

Treximet tablet: 

• Combination of 85 mg of sumatriptan with 500 mg of naproxen (an NSAID) (Law, 2010)

• This combination is more effective than either drug alone (Smith, 2020).

• The maximum dose in any 24 hour period is two tablets (FDA, 2011).

Sumatriptan can leave you feeling tired or drowsy, so don’t drive or do anything that requires you to be alert (FDA, 2013). Other side effects of the drug depend on how you take it.

People who take the oral sumatriptan tablet may experience an upset stomach or diarrhea, cramps, hot and cold flashes, or a tingling sensation. You might also feel tired, drowsy, or heavy (NIH, 2015)

The most common side effect reported by people who take nasal sumatriptan is that it leaves an unpleasant taste in their mouth (Smith, 2020). Other common side effects are a sore throat, irritation, or a tingling sensation in the nose, nausea, flushing, or an irregular or pounding heartbeat (NIH, 2019).

Patients who use sumatriptan self-injections can have a reaction at the injection site, including redness or irritation or a tingling or warm feeling. Other side effects include muscle cramps, nausea, and vomiting (NIH, 2017).

Some side effects of sumatriptan can be more serious. Symptoms such as tightness in the throat, neck, jaw, or chest, a pounding heartbeat, shortness of breath, and chest pains are all potentially serious side effects of sumatriptan (NIH, 2015). These signs can also be symptoms of something else entirely, such as a heart attack (FDA, 2013). If you experience any of these side effects, especially if you have ever had heart problems or if you are at risk for a heart attack, it is important to be evaluated by a healthcare professional.s

A healthcare provider may choose a different medication for you if you have any conditions or take any medications that could make sumatriptan potentially harmful to you. Here are some of the risk factors.

Heart disease or vascular conditions

Sumatriptan works by constricting blood vessels, which means it could be harmful to people who have heart disease or other blood vessel (vascular) conditions. These include coronary artery disease (CAD), a previous heart attack, transient ischemic attacks (TIA), Prinzmetal angina, hypertension, vasospasms, ischemic bowel disease, or a history of strokes or uncontrolled high blood pressure, among other conditions (FDA, 2013). 

Sumatriptan can also cause arrhythmias (irregular heartbeats) (FDA, 2013). Let your healthcare provider know if you’ve experienced this condition in the past. There may be alternative treatments that can better help alleviate your migraines. 

Drug interactions

Sumatriptan cannot be combined with ergot-containing medications. These medications, which include drugs like Cafergot, Ergomar, or Wigraine are also frequently prescribed for the treatment of migraines. Since both these and triptan drugs like sumatriptan constrict blood vessels, combining them can result in serious side effects and even death. 

Current guidelines recommend waiting at least 24 hours between taking an ergot medication and taking a triptan. Also, do not combine different triptan medications. (NIH, 2015). Tell your healthcare provider about any other medications you are taking. Sumatriptan can be very dangerous if combined with other medications, including some drugs used to treat anxiety and depression as well as drugs used to treat Parkinson’s disease (FDA, 2013).

Liver disease

People with liver disease may need a lower dose (FDA, 2013).

Let your healthcare provider know if:

• You have had an allergic reaction to sumatriptan or any ingredient in the medication 

• You have a history of seizure or any other condition that makes you prone to seizure

• You have a history of stroke or transient ischemic attack (TIA)

If you’re worried about whether your migraine medication is safe, speak to your healthcare provider. Understanding how your medication works and the risk factors will mean you’ll be armed with the knowledge to help you use your migraine drugs safely and effectively. 

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Current version

October 24, 2020

Written by

Hana Dethlefsen

Fact checked by

Yael Cooperman, MD

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About the medical reviewer

Yael Cooperman, MD, Ro

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.