From the Guidelines
Sumatriptan should be prescribed at a dosage of 25-100 mg orally every two hours, with a maximal dosage of 200 mg per day, for the treatment of migraines. The dosage of sumatriptan can vary depending on the severity of the migraine and the patient's response to the medication 1. For faster relief, sumatriptan is also available as a 6 mg subcutaneous injection, repeated in one hour if necessary, with a maximal dosage of 12 mg per 24 hours, or as an intranasal spray of 5-10 mg in one nostril, with a maximal dosage of 40 mg per day 1. It is essential to start with the lowest effective dose to minimize side effects, such as nausea, warmth, vomiting, vertigo, and malaise 1. Sumatriptan works by constricting blood vessels in the brain and blocking pain pathways by targeting serotonin receptors, and it is most effective when taken early in a migraine attack rather than waiting until the pain is severe 1. However, sumatriptan should not be used by people with heart disease, uncontrolled hypertension, or within 24 hours of taking other triptans or ergot medications 1. If sumatriptan doesn't provide relief after consistent use, it is recommended to consult a healthcare provider about alternative treatments, such as trying a different triptan or exploring other migraine management options 1. Some key principles of migraine management include trying a medication for two to three headache episodes before abandoning that line of therapy and selecting a migraine-specific drug that matches the patient's needs and the usual duration of the headache 1.
Some important considerations when prescribing sumatriptan include:
- Contraindications, such as ergotamine, MAOIs, use within 24 hours of another triptan, hemiplegic or basilar migraine, pregnancy, impaired hepatic function, or CAD 1
- Adverse reactions, such as nausea, warmth, vomiting, vertigo, malaise, headache, injection site reactions, and chest pressure and heaviness 1
- The potential for recurrence headaches, which can be relieved with a second dose of the medication, usually within 8-12 hours 1
From the FDA Drug Label
DOSAGE AND ADMINISTRATION 2. 1 Dosing Information The recommended dose of sumatriptan tablets is 25 mg, 50 mg, or 100 mg. The recommended dosage of sumatriptan for migraines is:
- 25 mg
- 50 mg
- 100 mg The maximum daily dose is 200 mg in a 24-hour period 2.
From the Research
Sumatriptan Dosage for Migraines
- The American Headache Society (AHS) considers sumatriptan, a triptan, as an effective treatment for acute migraine attacks 3.
- The administration of sumatriptan should follow the concept of "stratified care", where oral NSAIDs are the first choice for mild to moderate migraine attacks, and oral or nasal spray triptans are recommended for moderate to severe attacks 3.
- A combination of a triptan and a NSAID has been shown to yield a better efficacy compared with either therapy alone 3.
- The use of acute treatment, including sumatriptan, should be limited to a maximum of ten days a month to prevent medication-overuse headache 3.
- A systematic review and meta-analysis found that triptans, including sumatriptan, were significantly associated with reduced pain at 2 hours and 1 day, and increased risk of mild and transient adverse events 4.
- The strength of evidence for triptans, including sumatriptan, was graded as moderate to high, indicating a significant association with pain reduction and increased risk of adverse events 4.