Sumatriptan: everything you need to know

Sumatriptan is a drug most commonly used to treat migraines, either alone or in combination with non-steroidal anti-inflammatory drugs (NSAIDs), and cluster headaches. It can be taken by mouth, administered as an injection under the skin (subcutaneously), or in the nose (intranasally) as a liquid, spray, or powder. 

Sumatriptan is part of a group of medications that acts like a naturally occurring substance called serotonin in our brains. Serotonin is a neurotransmitter (meaning that it carries signals between the nerve cells in our bodies). While it’s not exactly clear how these drugs work to alleviate certain kinds of headaches, there are some theories. We’ve covered everything you need to know about sumatriptan, what it’s used for, and what types of side effects it can carry below.

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Migraines are not like any old headache. They often come with a range of associated symptoms like sensitivity to light or loud noises, nausea, vomiting, dizziness, numbness, double vision, or difficulty talking. For people with migraine disorders, many know one is coming because they experience something called an aura (visual signs that appear before a migraine starts). About one in every eight people will experience migraines, and they are more than three times as common in women than in men (Lipton, 2001). 

Fun fact: Your brain can’t actually feel pain directly. We know this because most brain surgeries are performed when patients are totally awake. But while your brain can’t feel pain, the layers that surround your brain, known as the meninges (pronounced meh-NIN-jeez), are very sensitive (Strassman, 1996). It appears that pain signals in those layers, as well as in a major nerve in our heads called the trigeminal nerve, get turned “on,” and while scientists have theories as to why this happens, the mechanism isn’t entirely clear (Bolay, 2002).

While we don’t always know what causes migraines, for people with chronic migraines, a pattern can sometimes emerge. Sleep disturbances, emotional stress, and hormonal changes (like menstrual periods or menopause) have all been identified as triggers in people prone to migraines. 

For others, migraines can be brought on by certain foods, alcohol, smells, or artificial sweeteners. Some doctors recommend keeping a “headache diary” and writing down everything you did/ate/drank or any recent changes in your life to identify triggers and avoid them. Studies show that migraines can be genetic in some cases, meaning that if your family members have them, you might be more likely to develop them yourself (Friedman, 2016). 

What does a migraine feel like? If you’ve ever had a migraine, you likely don’t need to be reminded of just how bad it is. But if you’ve ever known someone who has migraines, you might be wondering why they’ve locked themselves in their bedroom and turned off all the lights. 

Typically, a migraine headache is a throbbing headache (some people describe it as feeling like their heart is beating in their head). Sudden head movements usually make it worse, as does coughing or bending over. Sensitivity to light or sometimes even sound is a classic sign of migraine (Friedman 2016). 

Note that sumatriptan is not used to prevent migraines—it only works to treat them once they start. If your migraines are mild and not associated with nausea or vomiting, your healthcare provider will likely recommend that you try an over-the-counter pain medication such as acetaminophen (name brand Tylenol) or NSAIDs (such as Advil). If you do experience nausea or vomiting, you will also likely receive drugs known as antiemetics, which can help with these symptoms (Becker, 2015). 

If you experience moderate to severe migraine attacks that do not respond to over-the-counter pain medications like Tylenol, sumatriptan, and other triptan drugs (like zolmitriptan, frovatriptan, or almotriptan), or a combination of sumatriptan and an NSAID administered by mouth are two options your healthcare provider may recommend (Becker, 2015). 

If you experience an especially severe migraine and your regular treatment isn’t working, a healthcare provider may suggest the use of sumatriptan as a subcutaneous injection, which is a shot that is administered right under the skin (Kelley, 2012). 

Cluster headaches, though far less common than migraines (found in less than 1% of the population), are actually about four times more common in men than in women (Ekbom, 2002). Like migraines, cluster headaches are thought to involve a large nerve in the head/face called the trigeminal nerve. While the exact cause remains unclear, they appear to be more common among smokers (though quitting smoking doesn’t reverse the problem), and there’s definitely a genetic component—you are far more likely to experience cluster headaches if someone in your family has them too (Russel, 2001). 

One of the hallmark features of cluster headaches is that the pain typically appears on one side of the head during a given attack, either in one eye, above the eye, or next to the eye, and is often accompanied by tears, a droopy eyelid, or constriction of the pupil on that side (Manzoni, 1995).

For patients suffering from cluster headaches, the first-line treatment is 100% oxygen. While this is readily available in a hospital setting, it’s not usually available to patients at home. For those patients, the first choice for treatment is subcutaneous injections of sumatriptan, which are small syringes used to inject the medication under the skin. In patients who don’t have access to 100% oxygen and can’t tolerate subcutaneous injections, your healthcare provider may recommend using intranasal triptans (sprays, powders, or liquids that can be inhaled through the nose) (Obermann, 2015). 

These medications are usually well-tolerated and side effects typically resolve within 30 minutes after the drug is taken (Tfelt-Hansen, 1998). There are three different routes of administration for this medication: Sumatriptan can be prescribed as pills taken by mouth, injections that are injected under the skin, and forms that are administered via the nose (as powders, liquids, or sprays) (Schwedt, 2021). The side effects that accompany sumatriptan depend on the way you take the medication (May, 2020). 

• When administered as a tablet taken by mouth, sumatriptan is generally well tolerated though some patients report experiencing hot/cold flashes, chest pain/pressure or tightness, numbness, and fatigue. 

• When injected under the skin (subcutaneously), sumatriptan most commonly causes a tingling sensation, dizziness, or vertigo (which is a feeling like you’re moving, even when you’re not). Some people report feeling hot in general after receiving the medication. Others feel warmth at the site of injection, and some people develop redness or swelling at the site of injection. Just like with the sumatriptan pills, patients have reported a burning sensation, a sense of feeling heavy, or pressure, numbness or tightness in their chest, jaw, or neck. 

• When administered intranasally, the most commonly reported side effects are a loss of taste sensation or an unpleasant taste in the mouth. Many people also report nausea and vomiting. Some find that the intranasal administration is uncomfortable, causes pain or numbness in the nose, or irritates the nasal passage, causing runny nose or sinus discomfort. 

Because sumatriptan can cause dizziness, weakness, and drowsiness in some people, your healthcare provider will tell you not to drive or operate heavy machinery when taking this medication. In addition, there is evidence that sumatriptan increases the chance of seizures in people with a seizure disorder as well as in patients without a history of seizures.

Sumatriptan and other triptan medications are not meant to be used to prevent migraines or cluster headaches. Instead, they are meant to be used as “rescue” treatments to stop a headache when it starts. Doctors have found that using these medications more than ten days a month can cause an “over-use headache,” which will require that you stop using the medication (FDA, 2013).

Because sumatriptan can cause arrhythmias (abnormal heart rhythms), it should not be used in patients who have been diagnosed with this condition in the past. If you develop a new arrhythmia while taking the medication, your healthcare provider will stop the treatment. 

In patients with liver disease, sumatriptan is not cleared as effectively from their system, and, therefore, a healthcare provider may recommend using a lower dose. Like any drug, sumatriptan cannot be given to patients with a hypersensitivity or allergy to its components. 

Because the medication causes blood vessels to contract, it cannot be used in patients with a history of ischemic heart disease (such as a previous heart attack), vasospasms, Prinzmetal angina, a history of strokes or transient ischemic attacks (TIA), or in patients with uncontrolled high blood pressure. If your healthcare provider determines that you are at risk for these conditions, they may decide that this treatment is not right for you (FDA, 2013). 

Sumatriptan constricts blood vessels in the brain and, therefore, should not be taken within 24 hours of medications like ergotamine (brand names Ergocomp-PB, Belcomp PB, or others), which do the same thing, as the combined effect can be very dangerous (Worthington, 2013). 

In addition to triptan drugs, there are many drugs that act like serotonin or affect levels of natural serotonin in the body. Some can be used as antidepressants or antipsychotics or as treatments for Parkinson’s disease. 

Combinations of these medications can have serious effects on the levels of serotonin in the body, leading to a very dangerous condition known as serotonin syndrome. These include 5HT-1 agonists and monoamine oxidase inhibitors (MAOIs), which are medications sometimes used to treat depression or Parkinson’s disease—these include selegiline (brand name Emsam), phenelzine (brand name Nardil), and rasagiline (brand name Azilect), among others.

The symptoms of serotonin syndrome, which can be the result of drug interactions or accidental or intentional overdoses, can include anxiety, restlessness, or being disoriented. Patients may also be sweaty, have a fast heartbeat, high blood pressure, vomiting, or diarrhea in addition to tremor or shaking. Without treatment, this condition can be fatal. If you think you or someone you know may have taken too much of this medication, seek emergency medical attention (FDA, 2013). 

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Current version

August 31, 2020

Written by

Yael Cooperman, MD

Fact checked by

Mike Bohl, MD, MPH, ALM

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About the medical reviewer

Mike Bohl, MD, MPH, ALM

Dr. Mike is a licensed physician and a former Director, Medical Content & Education at Ro.