Sumatriptan Administration and Efficacy for Migraine Headaches

Alternative Routes of Administration

• Subcutaneous sumatriptan can be administered at a dose of 6 mg, which can be repeated after one hour, with a maximum daily dose of 12 mg per 24 hours, and intranasal sumatriptan can be administered at a dose of 5-10 mg (one to two sprays) in one nostril, which can be repeated after 2 hours, with a maximum daily dose of 40 mg per day 1

Efficacy Considerations

• Patients should try a medication for 2-3 headache episodes before abandoning that line of therapy 2

Combination Therapy

• The American College of Physicians recommends combining sumatriptan with an NSAID or acetaminophen if patients use an adequate dose of sumatriptan and still do not have sufficient pain relief 3
• Current guidelines recommend adding a triptan to an NSAID or acetaminophen when monotherapy does not provide sufficient pain relief 3

Important Contraindications

• Sumatriptan should not be used with ergotamine, MAOIs, or within 24 hours of another triptan, and is contraindicated in patients with hemiplegic or basilar migraine, pregnancy, impaired hepatic function, or coronary artery disease 1

Common Adverse Effects

• Common side effects of sumatriptan include nausea, warmth, vomiting, vertigo, malaise, headache, chest pressure and heaviness 2
• Subcutaneous administration of sumatriptan can cause injection site reactions in approximately 30% of patients 1

Managing Treatment Failure

• If inadequate response after dose optimization, consider switching to another triptan (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, or zolmitriptan) 3, 2
• Consider using a nonoral triptan and an antiemetic in people having severe nausea or vomiting 3