From the Guidelines
Triptans are not effective after the onset of an ocular migraine, and their use should be focused on treating the headache phase that often follows the visual disturbances. The effectiveness of triptans, such as sumatriptan, rizatriptan, and naratriptan, is well established for the treatment of migraine headaches, but their efficacy in treating ocular migraines after the onset of visual symptoms is limited 1. Triptans work best when taken at the earliest sign of a migraine headache, ideally before the pain phase begins, as they can constrict blood vessels and reduce inflammation in the brain 1. However, for ocular migraines, by the time visual symptoms appear, the neurological cascade has already been triggered, and triptans are unlikely to provide relief for the visual symptoms.
Some key points to consider when using triptans for migraine treatment include:
- The efficacy of triptans can vary depending on the specific medication and the individual patient, with sumatriptan showing efficacy in 70 to 82 percent of patients 1
- Triptans should be used with caution in patients with certain medical conditions, such as ischemic vascular conditions, vasospastic coronary disease, and uncontrolled hypertension 1
- The use of triptans can be associated with adverse reactions, such as nausea, vomiting, and dizziness, and patients should be monitored for these effects 1
In the case of ocular migraines, it is often recommended that patients rest in a dark, quiet room until the visual symptoms pass, typically within 30 minutes. For prevention of future episodes, regular use of triptans or other preventive medications may be considered, but this should be discussed with a healthcare provider. The limited effectiveness of triptans after the onset of an ocular migraine occurs because they cannot reverse the cortical spreading depression that causes the visual aura once it has started.
From the FDA Drug Label
SUMATRIPTAN tablets, USP are a serotonin (5-HT1B/1D) receptor agonist (triptan) indicated for acute treatment of migraine with or without aura in adults. The recommended dose of sumatriptan tablets is 25 mg, 50 mg, or 100 mg.
The effectiveness of triptans after the onset of an ocular migraine is not directly addressed in the provided drug labels. Key points:
- The labels indicate that sumatriptan is used for the acute treatment of migraine with or without aura in adults.
- There is no specific information regarding the effectiveness of triptans after the onset of an ocular migraine. 2 2
From the Research
Effectiveness of Triptans after Onset of Ocular Migraine
- The effectiveness of triptans after the onset of an ocular migraine is supported by several studies 3, 4, 5.
- Triptans, such as sumatriptan, are considered a first-line treatment for acute migraine attacks, including ocular migraines, and have been shown to be highly effective in improving headache and associated symptoms like nausea and photophobia 3.
- A study comparing the effectiveness of sumatriptan versus valproate in acute migraine found that while both treatments were effective, valproate had a faster response and was more effective without recurrence or remarkable side effects 4.
- However, it is noted that triptans are more efficacious when used in the early stages of a migraine attack 4.
- The use of triptans in the treatment of ocular migraines is not explicitly discussed in all studies, but their effectiveness in treating migraine attacks in general suggests they could be beneficial for ocular migraines as well 3, 5.
- A study on retinal, ophthalmic, or ocular migraine discusses the clinical presentation, pathophysiology, and appropriate evaluation and therapy, but does not specifically address the effectiveness of triptans after the onset of an ocular migraine 6.