From the Guidelines
Sumatriptan can be used to treat headaches in patients with Multiple Sclerosis (MS), but with caution and careful evaluation of the patient's cardiovascular status, as recommended by the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache 1. The standard dosing for acute migraine treatment is 50-100 mg orally, with a maximum daily dose of 200 mg, or 6 mg subcutaneously as needed. However, healthcare providers should exercise caution when prescribing sumatriptan to MS patients, as some may have cardiovascular risk factors that would contraindicate triptan use.
- Key considerations include:
- Evaluating the patient's cardiovascular status, as sumatriptan is contraindicated in patients with coronary artery disease, uncontrolled hypertension, or history of stroke.
- Monitoring patients for any worsening of neurological symptoms after taking sumatriptan, due to theoretical concerns about triptans potentially exacerbating MS symptoms.
- Considering potential drug interactions, particularly with antidepressants like SSRIs or SNRIs that are commonly prescribed in MS patients, as these combinations may increase the risk of serotonin syndrome.
- Starting with a lower dose may be prudent to assess tolerability in MS patients, as recommended by various studies, including those published in the American Family Physician 1 and Nature Reviews Neurology 1. It is essential to weigh the benefits and risks of sumatriptan use in MS patients and to carefully monitor them for any adverse effects, as suggested by the management of the acute migraine headache study 1.
From the FDA Drug Label
Sumatriptan tablets, USP are indicated for the acute treatment of migraine with or without aura in adults. Limitations of Use: Use only if a clear diagnosis of migraine headache has been established. The FDA drug label does not answer the question.
From the Research
Treatment of Headaches in Multiple Sclerosis (MS) Patients
- The prevalence of headaches in MS patients is higher compared to the general population 2.
- Headaches in MS patients can be primary or secondary, with migraine being a common comorbidity 2, 3.
- MS-specific therapy can improve migraine-like headaches caused by inflammation 2.
Use of Sumatriptan in Treating Headaches
- Sumatriptan is a potent and selective agonist at the vascular 5HT1 receptor, effective in treating acute migraine attacks 4, 5.
- The recommended dosage of sumatriptan for migraine is 100 mg orally or 6 mg subcutaneously 4.
- Sumatriptan is generally well tolerated, but should not be given to patients with ischemic heart disease, previous myocardial infarction, or uncontrolled hypertension 4, 5.
Considerations for Using Sumatriptan in MS Patients
- There is limited information on the use of sumatriptan in MS patients, and its effectiveness in this population is not well established 2, 3.
- Caution is warranted when selecting preventive medication for migraine in MS patients, as certain agents can magnify MS symptoms 3.
- Sumatriptan should be used with caution in patients with psychiatric illnesses, such as major depressive disorder and obsessive-compulsive disorder, due to the potential involvement of serotonin 6.