From the Guidelines
In Canada, the available nasal triptan sprays for the treatment of migraines are sumatriptan (Imitrex) and zolmitriptan is not mentioned in the provided evidence, however sumatriptan (Imitrex) is available in an intranasal form, with a dose of 5 to 10 mg (one to two sprays) in one nostril, which can be repeated after 2 hours to a maximal dosage of 40 mg per day 1. These medications work by binding to serotonin (5-HT1B/1D) receptors in cranial blood vessels, causing vasoconstriction and reducing inflammation, which helps relieve migraine pain. Some key points to consider when prescribing nasal triptans include:
- They offer advantages over oral formulations, including faster onset of action and effectiveness even when nausea prevents oral medication use.
- They are particularly useful for patients who experience rapid-onset migraines or those with significant nausea and vomiting.
- The recommended dose for sumatriptan nasal spray is 5 to 10 mg (one to two sprays) in one nostril, with a maximum daily dose of 40 mg.
- Patients should not use these medications more than 10 days per month to avoid medication overuse headaches.
- They are contraindicated in patients with cardiovascular disease, uncontrolled hypertension, or hemiplegic migraines, as stated in the evidence 1.
From the Research
Nasal Triptan Sprays Available in Canada
The following nasal triptan sprays are available in Canada:
Key Characteristics of Nasal Triptan Sprays
Some key characteristics of these nasal triptan sprays include:
- Rapid onset of action, with significant pain-free rates as early as 15 minutes post-administration 2, 4, 6
- High efficacy in the acute treatment of migraine, with headache response rates significantly higher than placebo 2, 4, 6
- Well-tolerated, with most adverse events being of short duration and mild or moderate intensity 4, 5, 6
- Available in various doses, including 5mg and 2.5mg for zolmitriptan nasal spray 4, 5
Comparison of Nasal Triptan Sprays
Comparing the two nasal triptan sprays: