Triptans

What it is

The most widely used class of prescription acute migraine treatments. Seven triptans are available — Imitrex (sumatriptan), Maxalt (rizatriptan), Relpax (eletriptan), Zomig (zolmitriptan), Frova (frovatriptan), Amerge (naratriptan), and Axert (almotriptan). They differ primarily in onset speed, duration of action, and formulation options. Sumatriptan has the longest track record and is available as a generic.

How it works

Selective serotonin (5-HT1B/1D) receptor agonists. Cause vasoconstriction of dilated cranial blood vessels and inhibit release of inflammatory neuropeptides including CGRP. Available in multiple formulations: oral tablets, nasal spray, subcutaneous injection, orally disintegrating tablets. Onset varies by formulation — subcutaneous sumatriptan fastest (10–15 min), oral tablets 30–60 min.

What patients need to know

Triptans are the most commonly prescribed prescription medications for stopping a migraine once it starts. They don't prevent migraines — they treat one that's already happening. There are several to choose from, and they work differently in different people, so if one doesn't help, another might. They come as pills, nasal sprays, and injections. They're not safe for people with certain heart or vascular conditions — your provider will screen for this.

Prior authorization

Most triptans are generic and do not require PA when on formulary. However, triptan failure is a standard prior authorization criterion for gepants, CGRP mAbs (for acute use), and some CGRP preventives. Documenting triptan failure accurately — which triptan, dose, duration of trial, reason for failure (inefficacy vs. side effects vs. contraindication) — is essential PA evidence. Patients with ≥10 triptan use days/month are at risk for medication overuse headache, which is relevant to PA clinical narratives.

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