How long should an adult patient with a history of migraines take sumatriptan (a triptan) for when experiencing a migraine?

How Long to Take Sumatriptan for a Migraine

Take sumatriptan as a single dose at migraine onset when pain is still mild, and if the headache persists or returns after 2 hours, you may take a second dose with at least 2 hours between doses, not exceeding 200 mg in 24 hours for oral formulations. 1

Timing of Administration

• Take sumatriptan immediately at headache onset when pain is still mild—not during the aura phase and not prophylactically—as early treatment significantly improves effectiveness compared to waiting until pain becomes moderate or severe. 2, 3

• Do not take sumatriptan during the aura phase before headache begins, as there is no evidence of benefit when taken before pain onset. 3

Single Attack Dosing Protocol

Oral Sumatriptan

• Start with 50-100 mg at migraine onset (50 mg provides optimal balance of efficacy and tolerability). 4, 1

• If headache persists or is not resolved by 2 hours after the first dose, take a second dose with a minimum 2-hour interval between doses. 1

• Maximum daily dose is 200 mg in any 24-hour period. 2, 1

Subcutaneous Sumatriptan

• Administer 6 mg at onset, which provides the fastest relief within 15 minutes with 70-82% response rate. 2, 4

• May repeat once after 1 hour if needed, with maximum of 12 mg per 24 hours. 2

Intranasal Sumatriptan

• Use 5-20 mg at onset, may repeat after 2 hours, with maximum of 40 mg per 24 hours. 2

Managing Headache Recurrence

• Approximately 40% of patients experience headache recurrence within 8-12 hours after initial response, which can be effectively treated with a second dose following the minimum interval requirements (2 hours for oral, 1 hour for subcutaneous). 2, 3

• This recurrence is related to sumatriptan's short half-life of approximately 2 hours. 5

Critical Frequency Limitations to Prevent Medication Overuse Headache

• Limit sumatriptan use to maximum 2 days per week or 4 headaches per 30-day period to avoid medication overuse headache. 4, 3

• Using triptans ≥10 days per month triggers medication overuse headache, defined as headache occurring on 15 or more days per month for at least 3 months due to overuse of acute medication. 6

• If you need sumatriptan more than 2 days per week, preventive migraine therapy should be initiated rather than increasing acute treatment frequency. 4

Trial Period Before Determining Effectiveness

• You must try sumatriptan for 2-3 separate migraine episodes before determining if it is effective for you, as response can vary between attacks. 2, 4, 3

• If inadequate response occurs after appropriate dosing across 2-3 attacks, consider switching to a different triptan (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, or zolmitriptan) as different triptans work for different patients. 6, 2, 3

Optimizing Effectiveness with Combination Therapy

• If 100 mg sumatriptan provides insufficient relief, add an NSAID (naproxen, ibuprofen, or diclofenac) or acetaminophen rather than increasing triptan dose or frequency. 2

• Combination therapy of triptan plus NSAID taken together at onset is more effective than either medication alone or increasing triptan frequency. 6, 2

Common Pitfall to Avoid

• Never take sumatriptan within 24 hours of another triptan or ergotamine derivatives (including DHE), as this is an absolute contraindication. 2, 4, 3

• Do not use sumatriptan with current MAOI use or within 2 weeks of MAOI discontinuation. 2, 4, 3