Mechanism of Action and Clinical Implications of Triptans

Primary Mechanism of Action and Clinical Implications

Triptans are most effective when taken early in a migraine attack while pain is still mild, as recommended by the American Academy of Neurology 1
The American Family Physician guidelines state that triptans are contraindicated in patients with ischemic vascular conditions, vasospastic coronary disease, uncontrolled hypertension, and other significant cardiovascular disease due to their vasoconstrictive properties 2
The American Family Physician also recommends that triptans should not be used in patients with significant cardiovascular disease, with a strength of evidence rated as high 3

If one triptan is ineffective, another triptan may still provide relief due to slight pharmacological differences, as suggested by the American Family Physician and the American Academy of Neurology 1, 3
The Mayo Clinic Proceedings guidelines advise against combining triptans with ergotamine derivatives due to the risk of additive vasoconstrictive effects, and also note a theoretical risk of serotonin syndrome when triptans are combined with SSRIs or SNRIs 4