Sumatriptan : treatment across the full spectrum of migraine

Triptans are the first-line treatment for moderate-to-severe migraine headaches. Sumatriptan , the first triptan, is available in different formulations, including subcutaneous (SQ), intranasal, transdermal, oral, and suppository options.

Sumatriptan formulations have different pharmacokinetic, efficacy, and adverse event profiles. The fastest and most complete migraine relief occurs with SQ dosing; a needle-free option is available for patients fearful of injections. Oral administration is generally preferred by patients, although variability with absorption limits efficacy, especially for more severe attacks. Intranasal, transdermal, and suppository formulations are options for patients with nausea who do not require or prefer to avoid SQ administration. Transdermal treatment may be limited in some cases by skin irritation.

Patients should use an attack-based treatment approach for their migraine attacks to balance the speed of relief, efficacy, and tolerability. Different sumatriptan formulations allow its use as both first-line and rescue therapies, with additional treatment if needed. This article develops a treatment algorithm that offers suggested roles for different formulations of sumatriptan based on attack severity and response to initial sumatriptan therapy.