What types of headaches are triptans (triptans) used to treat?

Triptans for Headache Treatment

Triptans are specifically indicated for the acute treatment of migraine headaches with or without aura and for cluster headaches, but are not indicated for tension-type headaches or other primary headache disorders. 1, 2, 3, 4

Primary Indications for Triptans

• Migraine headaches with or without aura: First-line acute treatment option for moderate to severe migraine attacks
• Cluster headaches: Effective for acute treatment
• NOT indicated for:
  • Prophylactic therapy of migraine attacks
  • Tension-type headaches
  • Medication overuse headaches
  • Hemiplegic or basilar migraine (contraindicated)

Optimal Use of Triptans for Migraine

Triptans are most effective when taken early in a migraine attack while pain is still mild 1. The American Academy of Neurology recommends:

• Timing: Administer as soon as possible after headache onset
• Combination therapy: Consider combining with NSAIDs or acetaminophen for moderate to severe migraines
• Dosing limitations: Use no more than 9 days per month to prevent medication overuse headache 1

Contraindications for Triptan Use

Triptans should not be used in patients with:

• History of coronary artery disease or coronary vasospasm
• Wolff-Parkinson-White syndrome or other cardiac conduction disorders
• History of stroke, transient ischemic attack, hemiplegic or basilar migraine
• Peripheral vascular disease or ischemic bowel disease
• Uncontrolled hypertension
• Recent use (within 24 hours) of another triptan or ergotamine-containing medication
• Concurrent or recent (past 2 weeks) use of MAO inhibitors 2, 3

Available Triptan Formulations

Multiple formulations provide options for different patient needs:

• Oral tablets: Standard option (sumatriptan, rizatriptan, zolmitriptan, etc.)
• Nasal sprays: Faster onset, useful for patients with nausea/vomiting
• Subcutaneous injection: Fastest onset, highest efficacy (51% therapeutic gain vs. 32% for oral) 5
• Orally disintegrating tablets: Useful for patients who have difficulty swallowing during attacks

Common Pitfalls in Triptan Use

1. Delayed administration: Triptans are most effective when taken early in an attack while pain is still mild 1
2. Medication overuse: Using triptans more than 9 days per month can lead to medication overuse headache 1
3. Inadequate dosing: Starting with too low a dose may result in treatment failure
4. Not trying alternative triptans: If one triptan fails, another may be effective due to pharmacokinetic differences 5
5. Missing contraindications: Careful screening for cardiovascular risk factors is essential before prescribing 2, 3

When Triptans Fail or Are Contraindicated

If triptans fail or are contraindicated, consider:

• Ditans (lasmiditan) or Gepants (ubrogepant, rimegepant) as third-line treatment 1
• NSAIDs alone (though generally less effective than triptans)
• Neuromodulatory devices for patients with contraindications to pharmacotherapy
• Preventive therapy if acute attacks are frequent or difficult to treat

The evidence clearly shows that triptans are specifically developed for and most effective in migraine and cluster headaches, with FDA approval specifically for these conditions 2, 4. While some research has explored their use in other headache disorders, the evidence base and regulatory approval remain focused on migraine and cluster headaches.