Will Rizatriptan (rizatriptan) be effective for migraines that have lasted several hours?

Efficacy of Rizatriptan for Migraines That Have Lasted Several Hours

Rizatriptan can still be effective for migraines that have lasted several hours, though it is most effective when taken early in the migraine attack. 1, 2

Timing of Triptan Administration

• Triptans, including rizatriptan, are most effective when taken early in a migraine attack, but can still provide relief even after several hours 1
• Rizatriptan has a relatively rapid onset of action, reaching peak blood concentration in 60-90 minutes, which is faster than most other oral triptans 1
• Treatment should begin as early as possible during the migraine attack to maximize efficacy, but delayed administration may still provide benefit 2

Efficacy Considerations

• Rizatriptan 10 mg has demonstrated pain relief in approximately 71% of patients within 2 hours of administration 3
• Even when administered for established migraines, rizatriptan can provide:
  • Relief from associated symptoms such as nausea 4
  • Improvement in functional ability 4
  • Complete pain relief in up to 42% of patients within 2 hours 3

Dosing Recommendations

• Rizatriptan 10 mg is more effective than the 5 mg dose for pain relief and should be considered for established migraines 5, 3
• For migraines that have lasted several hours, combination therapy may be more effective:
  • Combining rizatriptan with acetaminophen or an NSAID (like naproxen) provides greater benefit than rizatriptan alone 1, 2
  • The combination of rizatriptan and acetaminophen results in a higher likelihood of pain freedom at 2 hours (300 more events per 1000 treated people) compared to acetaminophen alone 1, 2

Important Precautions

• Avoid using rizatriptan if you have:
  • Ischemic heart disease 6
  • Uncontrolled hypertension 6
  • Vasospastic coronary disease 6
• Be cautious about medication overuse headache:
  • Limit rizatriptan use to avoid rebound headaches 7
  • Triptans should not be used more than 10 days per month to prevent medication overuse headache 2, 7

Clinical Pearls

• If one triptan is ineffective, trying a different triptan may be beneficial 1
• For migraines with significant nausea or vomiting, consider rizatriptan MLT (orally disintegrating tablet) which is absorbed without requiring water 1
• Patients should try a medication for 2-3 headache episodes before abandoning that line of therapy 1
• For frequent migraines (more than 2 per week), consider adding preventive therapy rather than increasing acute medication use 7