Table of Contents
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Migraines and cluster headaches are so much more than just severe headaches. They can stop you from working, going to school, and otherwise just functioning and getting on with your day. When the pain of a migraine can last anywhere from 4 to 72 hours, you want relief (Wootton, 2020). The last thing you want is uncomfortable or harmful side effects.
Sumatriptan (brand name Imitrex) is one of the most commonly used drugs to treat moderate to severe migraine headaches and works well for many patients (Smith, 2020). However, migraine treatment is very individual. It may take some time for you and your healthcare provider to figure out which medication or combination of drugs is most effective, with the fewest possible side effects. Here, we’ll dig into sumatriptan’s side effects so you’ll be able to talk to your healthcare provider and find the right treatment for you.
What is sumatriptan used to treat?
Sumatriptan is most commonly used to treat certain headache syndromes, such as migraines and cluster headaches. Migraines and cluster headaches are more than just regular headaches. Migraines include a whole range of symptoms, including sensitivity to light and sound, and for some people, even nausea, vomiting, and dizziness, numbness, difficulty speaking, or double vision (Friedman, 2016).
One in eight people experience migraines, and they are more common for women (Lipton, 2001). Cluster headaches, however, are more common in men, and typically the pain usually appears on one side of the head, usually near the eye (Ekbom, 2002; Manzoni, 1995).
What is Imitrex, and what are its side effects?
Imitrex is the brand name for the generic drug sumatriptan. All forms of sumatriptan are effective and well-tolerated by most patients. The side effects usually resolve within 30 minutes from the time the medication is taken, and only a small number of patients experience serious side effects (Tfelt-Hansen, 1998; Perry, 1998).
It’sIt’s important to remember, though, that sumatriptan is a rescue medication meant to be taken only during migraines and not a drug that can be used daily to prevent them. Excessive use of sumatriptan can lead to medication overuse headaches (also called “rebound headaches”). Patients shouldn’t take sumatriptan more than ten times per month (Smith, 2020).
Sumatriptan can be administered by mouth as a pill, in the nose (intranasally), and under the skin (subcutaneously). Sumatriptan dosage and possible side effects will depend on how you take it. Common side effects across all three methods include dizziness, tiredness, and feeling weak, so do not drive or operate any heavy machinery after taking sumatriptan (FDA, 2013). Your healthcare provider will decide which medication is right for you.
Sumatriptan tablets are often prescribed in doses of 50 mg or 100 mg, but 25 mg doses are sufficient for some patients. The maximum dose is 200 mg in a 24 hour period (Smith, 2020). Some people experience nausea and vomiting with their migraines, which makes pills taken by mouth problematic. (It’s important to keep the medication in your body if it’s going to work.)
People who take sumatriptan by mouth tend to experience the fewest side effects. However, possible side effects include hot and cold flashes, a tingling feeling or flushing of the skin, feeling dizzy, drowsy, or a feeling of weakness or muscle cramps. Some people get an upset stomach or experience nausea or diarrhea (NIH, 2015). While pressure in the chest, jaw, or neck can be side effects of sumatriptan, they can also be signs of a more serious condition, like a heart attack. If you experience any of these symptoms, seek medical attention.
Sumatriptan: everything you need to know
For people who have nausea or vomiting during migraines, sumatriptan can be inhaled through the nose either as a spray, powder, or liquid, and dosage will depend on the exact medication (Smith, 2020).
Intranasal forms are faster acting and more effective than oral sumatriptan, offering relief in as little as 15 minutes (Worthington, 2013; Negro, 2018). Nasal sumatriptan (brand name Imitrex) side effects include some that are directly related to being administered into your nose: nose tingling, irritation, and soreness, a sore throat, or dry mouth. Some patients report that they leave a bad taste in the mouth. Other side effects are similar to other forms of administration, including (NIH, 2015):
- feeling tired or weak
- a pounding or irregular heartbeat
- feeling warm, or experiencing flushing (blushing) of the skin
Sumatriptan injections can provide relief in as few as ten minutes, making them the fastest and most effective form of the medication (Perry, 1998). These are available as both needle-based and needle-free (compressed gas) self-injections, and patients can easily administer these in their thigh, arm, or abdomen, depending on the format (Rothrock, 2010). Sumatriptan injections are usually prescribed in 6mg doses. However, your healthcare professional may prescribe smaller doses of 3mg and 4mg, which you may need to inject repeatedly instead of all at once. That said, the maximum dosage is only 6mg per dose and 12mg for every 24 hours (Smith, 2020).
However, these can cause the most side effects and are the most costly (Derry, 2014). Because this type of sumatriptan is injected, common side effects include irritation, redness, a warm feeling, or tingling where the medication was injected. Other side effects include drowsiness, dizziness, upset stomach, vomiting, muscle cramps, or feeling pressure or heaviness in your chest (NIH, 2017).
How does Imitrex work?
Imitrex’sImitrex’s active ingredient is sumatriptan succinate. Sumatriptan is part of a group of drugs called triptans. Triptans are “rescue drugs,” which means you take them at the first sign of a migraine or cluster headache, rather than as a preventative drug. Unlike pain relievers, which stop the pain, triptans work to stop the migraine’s progress. Because of this, they’re most effective when taken early, as soon as the pain begins (Worthington, 2013). Migraines can last up to three days, so getting early and effective relief can make a huge difference (Smith, 2020).
How do triptans stop migraines? To be honest, it’s not completely clear. Researchers are still figuring out exactly how migraines work (and, therefore, how to stop them), but constricting blood vessels in the brain is one thing that helps. Triptans cause blood vessels in the brain to contract, but the bonus effect is that they block the pain pathway, too (Ahn, 2005).
Sumatriptan drug interactions
Some healthcare providers prescribe sumatriptan together with a pain reliever like Naproxen or other NSAIDs (non-steroidal anti-inflammatory drugs) like Advil. Alternatively, they may prescribe a medication that includes a combination of the two. This is because research shows that a combination is more effective for some patients (Worthington, 2013).
Sumatriptan works partly by narrowing blood vessels. Use other medications that do the same under the guidance of a medical professional. For example, sumatriptan should not be used within 24 hours of ergotamines like Cafergot, Ergomar, Wigraine, or any other ergot-type drugs (NIH, 2015).
Because sumatriptan acts like serotonin, it should also not be taken together with other medications that act like or regulate the body’s serotonin levels. Medications like antidepressants, anti-psychotics, and certain treatments for Parkinson’s disease such as selegiline (brand name Emsam), phenelzine (brand name Nardil), and rasagiline (brand name Azilect) may be unsuitable to use together with sumatriptan because they can increase the chances of a condition known as serotonin syndrome (FDA, 2013)
Serotonin syndrome: symptoms, causes, treatment
Serotonin syndrome can occur when there is too much serotonin in the body. This can happen when taking too much or a combination of serotonin-related medications. People with serotonin syndrome may feel disoriented, anxious, restless, or could experience hallucinations. Additional symptoms are sweating, a fast heartbeat, high blood pressure, vomiting, diarrhea, tremors, shaking or muscle spasms, and unusual eye movements. If you experience these symptoms after taking sumatriptan, seek emergency medical attention. Without treatment, this condition can be severe and even fatal (Heller, 2018).
Is sumatriptan a narcotic?
Sumatriptan is not a narcotic. It’s a triptan. Narcotics are pain relievers from a class called opioids and include medications like codeine and morphine (Vorvick, 2019). While the most common and effective treatment for migraine involves the use of triptans and NSAIDs, if those treatments fail, your healthcare provider may consider a narcotic option. Treatment with narcotics can be dangerous and habit-forming and requires close monitoring (Worthington, 2013).
Who shouldn’t use sumatriptan?
Although sumatriptan is effective and works for many people, it isn’t the best choice for some patients. Sumatriptan works in part because it constricts blood vessels in the brain. Although this is good for combating migraine, it may not be suitable for people with heart disease and vascular conditions. These include, but are not limited to, hypertension, vasospasms, Prinzmetal angina, ischemic bowel disease, coronary artery disease (CAD) or previous heart attack, transient ischemic attacks (TIA), or a history of strokes or uncontrolled high blood pressure. Your healthcare provider may find an alternative migraine treatment if you have any of these or other related conditions (FDA, 2013).
Arrhythmias (irregular heartbeats) are a potential side effect of sumatriptan. If you have an arrhythmia or have experienced an arrhythmia in the past, sumatriptan may not be the right treatment option for you. People with a history of seizures or liver disease may require monitoring when using this medication (FDA, 2013).
You should not use sumatriptan if you have ever had an allergic reaction to it or any of its ingredients.
Migraine and cluster headache medication can vary in effectiveness from person to person. Finding the right medication strategy for you will be a custom experience based on discussions between you and your healthcare provider. The medication they prescribe will be based on the types of symptoms you have, their severity, and whether you’re taking any other medications or have any other medical conditions.
Chronic pain syndrome: what is it, symptoms, treatment
Sumatriptan has been shown to be effective and with fewer side effects than other migraine medications. You may try a few medications on your way to finding the right migraine treatment for you, and a part of that journey will be making sure you can reduce the impact of side effects.
- Ahn, A. H., & Basbaum, A. I. (2005). Where do triptans act in the treatment of migraine? Pain, 115(1), 1–4. doi: 10.1016/j.pain.2005.03.008. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1850935/
- Derry, C. J. (2014, May 24). Sumatriptan (all routes of administration) for acute migraine attacks in adults ‐ overview of Cochrane Database of Systematic Reviews, 5: CD009108. doi: 10.1002/14651858.CD009108.pub2. Retrieved from https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009108.pub2/full
- Ekbom, E., Svensson, K., Träff, D., & Waldenlind, H. (2002, March). Age at onset and sex ratio in cluster headache: Observations over three decades. Cephalalgia: An International Journal of Headache, 22(2), 94–100. doi: 10.1046/j.1468-2982.2002.00318.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11972575/
- Friedman, D. I. (2016). Your Loved One Has Migraines. Headache: The Journal of Head and Face Pain, 56(8), 1368-1369. doi: 10.1111/head.12880. Retrieved from https://headachejournal.onlinelibrary.wiley.com/doi/abs/10.1111/head.12880
- GlaxoSmithKline. (2013, November). Imitrex Tablets Sumatriptan succinate, FDA Approved Label. Retrieved September 3, 2020, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/020132s028,020626s025lbl.pdf
- Heller, J. L. (2018, April). Serotonin syndrome: MedlinePlus Medical Encyclopedia. MedlinePlus. Retrieved from https://medlineplus.gov/ency/article/007272.htm
- Lipton, R. B., Stewart, W. F., Diamond, S., Diamond, M. L., & Reed, M. (2001). Prevalence and Burden of Migraine in the United States: Data From the American Migraine Study II. Headache: The Journal of Head and Face Pain, 41(7), 646-657. doi: 10.1046/j.1526-4610.2001.041007646.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11554952/
- Manzoni, G. C., Terzano, M. G., Bono, G., Micieli, G., Martucci, N., & Nappi, G. (1983). Cluster Headache — Clinical Findings in 180 Patients. Cephalalgia, 3(1), 21-30. doi: 10.1046/j.1468-2982.1983.0301021.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/6850818/
- National Institutes of Health. (2015, November). Sumatriptan: MedlinePlus Drug Information. MedlinePlus. Retrieved September 3, 2020, from https://medlineplus.gov/druginfo/meds/a601116.html
- National Institues of Health. (2017, December). Sumatriptan Injection: MedlinePlus Drug Information. MedlinePlus. Retrieved September 3, 2020, from https://medlineplus.gov/druginfo/meds/a696023.html
- National Institutes of Health. (2019, September). Sumatriptan Nasal: MedlinePlus Drug Information. MedlinePlus. Retrieved September 3, 2020, from https://medlineplus.gov/druginfo/meds/a614029.html
- Negro, A., Koverech, A., & Martelletti, P. (2018). Serotonin receptor agonists in the acute treatment of migraine: a review on their therapeutic potential. Journal of Pain Research, 11: 515–526. doi: 10.2147/jpr.s132833. Retrieved from https://www.dovepress.com/serotonin-receptor-agonists-in-the-acute-treatment-of-migraine-a-revie-peer-reviewed-fulltext-article-JPR
- Perry, C. M., & Markham, A. (1998). Sumatriptan. Drugs, 55(6), 889–922. doi: 10.2165/00003495-199855060-00020. Retrieved from https://link.springer.com/article/10.2165/00003495-199855060-00020
- Rothrock, J. F. (2010). Injectable Sumatriptan: Now Needle-Based or Needle-Free: AMF. Retrieved 10 September, 2020, from https://americanmigrainefoundation.org/resource-library/oral-and-intranasal-triptans-for-migraine/
- Smith, J.H. (2020, August). Acute treatment of migraine in adults. Retrieved September 3, 2020, from https://www.uptodate.com/contents/acute-treatment-of-migraine-in-adults?topicRef=734&source=see_link
- Tfelt-Hansen, P. (1998). Efficacy and Adverse Events of Subcutaneous, Oral, and Intranasal Sumatriptan Used for Migraine Treatment: A Systematic Review Based on Number Needed To Treat. Cephalalgia, 18(8), 532-538. doi: 10.1046/j.1468-2982.1998.1808532.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/9827244/
- Vorvick, L. J. (2019, May). Pain medications – narcotics: MedlinePlus Medical Encyclopedia. MedlinePlus. Retrieved September 3, 2020, from https://medlineplus.gov/ency/article/007489.htm
- Wootton, R.J. (2020, February). Patient education: Migraines in adults (Beyond the Basics). Retrieved September 3, 2020, from https://www.uptodate.com/contents/migraines-in-adults-beyond-the-basics
- Worthington, I., Pringsheim, T., Gawel, M. J., Gladstone, J., Cooper, P., Dilli, E., et al. (2013). Canadian Headache Society Guideline: Acute Drug Therapy for Migraine Headache. The Canadian Journal of Neurological Sciences, 40(S3). doi: 10.1017/s0317167100017819. Retrieved from https://www.cambridge.org/core/product/identifier/S0317167100017819/type/JOURNAL_ARTICLE
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.