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About sumatriptan

Sprays and tablets

Dr Fox supplies Imigran nasal sprays (10mg & 20mg) and sumatriptan tablets in 50mg and 100mg strengths for the relief of migraines. 'Sumatriptan' is the active ingredient in Imigran. Generic sumatriptan tablets cost less than branded Imigran tablets, but are medically the same (see generic medicines FAQs page).

How does sumatriptan work?

Migraine occurs when blood vessels inside the head swell temporarily. Sumatriptan tablets and nasal sprays reduce the swelling of the blood vessels and this helps to relieve headache and other migraine symptoms.

Buying sumatriptan online

Whilst sumatriptan is available over the counter, it is always recommended to consult your GP to confirm the diagnosis before obtaining supplies of migraine treatment online. Consult your GP if your symptoms are changing or you experience any new medical conditions or side effects. Checks are carried out online, but this does not replace a consultation with your own doctor.

Who can take sumatriptan?

Imigran/sumatriptan is for people who have been diagnosed with migraine, not for other sorts of headaches. Migraine headaches are typically throbbing and severe, and are associated with nausea, vomiting, and photophobia (aversion to strong light). The headaches are usually localised to one side of the head, but not always, and are sometimes preceded by symptoms such as flashing lights or other visual or sensory disturbance (aura). They usually last a few hours and then resolve, with no symptoms in between. There are many variants.

See NHS migraine and NHS sumatriptan for further details.

Who should not use sumatriptan?

Discuss your treatment with your GP and don't use sumatriptan without approval if any of the following apply:

• A history of fits or seizures.
• Serious liver or kidney disease.
• Over 65 years old.
• You are a heavy smoker (over 25 cigarettes/day), are a man over 40, or a woman past the menopause - you may be at extra risk of developing heart disease and may need extra checks from your GP before taking sumatriptan.
• Have had a heart attack, stroke, or mini-strokes (TIAs) in the past.
• Problems with poor circulation (peripheral vascular disease).
• Angina (heart pain on exertion).
• Irregular heart rhythm.
• You have uncontrolled high blood pressure.

Taking sumatriptan with other medicines

Sumatriptan (Imigran) belongs to a group of medicines called triptans, and should not be taken at the same time as other triptans used to treat migraine, including naratriptan, rizatriptan, and zolmitriptan. Other migraine treatments may interact, namely ergotamine or similar medicines. Leave at least 24 hours between taking these medications and sumatriptan.

Triptans, including sumatriptan, have been used in clinical trials at the same time as Vydura (rimegepant - used as a preventative medication), with no issues reported.

See the 'other medicines' section of the manufacturers leaflet for further details.

Sumatriptan should not be taken within 2 weeks of MAOIs (monoamine oxidase inhibitors antidepressants) and can interact with other antidepressants known as SSRIs, or SNRIs and herbal remedies containing St John's Wort.

Talk to your doctor, before taking sumatriptan, if you take any antidepressant medication.

Dr Fox checks for interacting medication in the online migraine consultation.

Can sumatriptan be taken in pregnancy and whilst breastfeeding?

There is no evidence of increased risk of birth defects with sumatriptan in pregnancy, but there is only limited information. The risks and benefits of treatment should be discussed with a doctor before taking sumatriptan in pregnancy.

Despite the fact that minimal amounts get into breast milk, manufacturers recommend not to breastfeed or use expressed milk within 12 hours of using sumatriptan.

Further information can be found at BUMPS - Sumatriptan.

Possible side effects of sumatriptan

Serious allergic reactions (rash, hives, wheezing, swollen eyelids and face, and collapse) are very rare, but if they occurred would require immediate medical attention - telephone 999 in the UK.

Do not take sumatriptan if you have known allergy to other triptans, or to sulphonamide antibiotics (rarely used).

Not all people experience side effects and some symptoms may actually be caused by the migraine itself.

Common side effects with sumatriptan tablets and Imigran spray (affecting up to 1 in 10 people) may include: aching muscles, shortness of breath, dizziness, tiredness, nausea (feeling sick), temporary increase in blood pressure.

A common side effect with the nasal spray is an unpleasant taste in the back of the mouth, and irritation in the nose and throat.

Other side effects are possible and include: seizures, visual disturbance, heart problems (angina, changes in heart rhythm, heart attack), reduced peripheral circulation (cold hands and feet), feeling faint, joint pains, anxiety, and sweating.

A full list can be found in the manufacturer's patient leaflet.

How to use Imigran nasal spray

It is best to start treatment as soon as you feel a migraine headache coming on, although treatment can be used any time during the headache. Imigran (sumatriptan) doesn't work if started during the aura phase.

Imigran nasal spray comes in a single dose bubble pack and should be stored in the pack until use. There is a 20mg and a 10mg strength. Adults 18 to 65 years usually use one 20mg spray into just one nostril. But one 10mg spray into one nostril is enough for some people. The dose can be repeated after 2 hours if required, but only if there was improvement with the first dose. If symptoms have resolved completely, there is no need to repeat the dose. Maximum of 2 sprays in 24 hours. Not to be used at the same time as sumatriptan tablets or other triptan tablets.

Details about how to use the nasal spray can be found in the manufacturer's patient leaflet.

How to take sumatriptan tablets

Sumatriptan tablets are not a preventative for use when there are no symptoms. They work best if taken as soon as a migraine headache is coming on, but can be taken any time after the headache has started. Do not take them during the aura phase. The usual dose is one 50mg tablet, swallowed whole, but some people require the higher strength 100mg tablet. You can take a second tablet after 2 hours, but only if symptoms are continuing and have partially responded to the first tablet. The maximum dose in 24 hours is 300mg (6 x 50mg tablets or 3 x 100mg tablets). Not to be used at the same time as the Imigran spray or other triptan medications.

Alternative treatments

Migraines will often improve after a few hours lying down in a darkened room. Simple painkillers, such as ibuprofen and aspirin, may be effective. Other triptans used to treat migraine include naratriptan, rizatriptan, zolmitriptan. It may be worth trying different triptans to find the one which suits you best. If you have tried two different triptans unsuccessfully, then you can try Vydura (rimegepant). It can also be used in many cases where there are medical contraindications to using triptans.

If vomiting is marked, an anti-sickness tablet or suppository can help. Some migraine tablets contain a combination of painkillers and antiemetics. Painkillers which contain codeine and other 'opiates' should usually be avoided as they can increase sickness and are potentially addictive.

People who get frequent migraines, sometimes defined as two or more attacks a month, or where acute treatment is not effective, may be suitable for long term preventative treatments, such as daily beta-blocker tablets or other heart or blood pressure tablets, pizotifen, amitriptyline, or epilepsy treatments such as topiramate or sodium valproate. Vydura can also be used as a preventative treatment. Consult with your GP if you think a preventative migraine treatment may help you.

There is ongoing research into migraine treatments and some newer preventative treatments are available, usually only from migraine specialists. These include botox injections, monoclonal antibody therapies (erenumab, fremanezumab and galcanezumab), and magnetic and nerve stimulation techniques. Alternative therapies include acupuncture and various herbs (feverfew) and other supplements.

Comparing different triptans