If your triptan isn’t working as well as you’d hoped, it may not be the medication itself. A few common factors — including timing, dose, and how your body absorbs the drug — can all affect its effectiveness.
Timing
When triptans don’t work well, timing is often a big part of the problem, says Holdridge.
“Taking the medication early gives it the best chance to interrupt the migraine process before the attack fully builds,” she says.
If you’re in the habit of holding off on taking your triptan to find out how severe an attack might be, you’re probably waiting too long. “Waiting too long will make it ineffective for that day’s migraine,” says Dharti Dua, MD, a neurologist who specializes in treating headache and migraine at The Ohio State University Wexner Medical Center in Columbus.
Too Low of a Dose
Dosing errors are another common issue, and one that often happens unintentionally. Some people are prescribed a dose that may need adjustment, while others reduce the dose on their own by splitting pills to make their monthly supply last longer, says Dr. Dua.
That strategy can backfire. “Taking less than the prescribed dose may not fully stop the migraine, which increases the likelihood that symptoms return later the same day or the next,” says Holdridge.
Gastric Stasis or Vomiting During an Attack
For some people, the issue is not timing or dose but the way the medication is getting into the body.
Migraine can slow the digestive system during an attack, a phenomenon often referred to as gastric stasis or gastroparesis, which can delay how quickly an oral medication is absorbed. That may make a pill work more slowly or less reliably when you need fast relief.
For people experiencing gastric stasis, an injectable triptan or a nasal spray may be an effective option, says Holdridge. “An injectable is by far the fastest-acting formulation, followed by a nasal spray,” she says.
These options can be especially helpful for people whose migraine attacks escalate quickly or who experience nausea and vomiting early in an attack, says Holdridge.
That’s a real issue for some people: Vomiting can prevent an oral medication from being absorbed at all, says Dua.
Wrong Drug for You
Even when triptans are taken correctly, the specific drug may not be the best fit.
The seven triptans approved by the U.S. Food & Drug Administration differ in how quickly they take effect, how long they stay active in the body, how they’re delivered, and what side effects they may cause. That can make a difference, because some people need faster relief, while others do better with a longer-acting medication.
“Sometimes people who don’t get effective relief from one triptan will respond to another triptan or another formulation of triptan,” says Dua.
Some migraine patterns can also influence which triptan is a better match. Menstrual migraine, for example, often responds better to frovatriptan or naratriptan, she says. These drugs can be used in a prophylactic manner if the migraine attacks are predictable during this time.
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