Sumatriptan

Sumatriptan is an acute treatment taken to help reduce symptoms when you start to experience a migraine attack. It is part of a class of medications called triptans.

There are many different acute treatments available, so it can be helpful to know what they are before speaking to your doctor. This article will help you better understand sumatriptan as one of your acute treatment options.

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Medically reviewed by Dr Trudy Cheng. Last updated September 7, 2023.

What is sumatriptan?

Sumatriptan is part of a class of medications called ‘triptans’, which belong to a group of drugs called serotonin agonists. Triptans are acute treatments that were developed specifically to treat migraine. They are taken to help reduce symptoms when you start to experience a migraine attack.

Migraine is a neurological disorder that can be debilitating. Some of the symptoms include head pain, light or sound sensitivity, nausea, visual disturbances, and more.

Sumatriptan is used to treat migraine and can be taken orally in tablet form, as a nasal spray and as an injection. In addition to migraine, the injectable forms of sumatriptan are used to treat cluster headache – a relatively rare and extremely painful type of headache that has symptom and treatment overlaps with migraine (1).

Picture of Imigran packaging, which is a type of triptan.

Sumatriptan at a glance

Active ingredientSumatriptan
Brand names & manufacturersImigran (Aspen Pharmacare Australia)
Sumatran (Arrow Pharma)
Iptam (Alphapharm trading as Viatris)
Clustran (Sun Pharma ANZ)
Full list including generic >
IndicationsMigraine; cluster headache (injection only)
FormulationsTablets; Fast disintegrating tablets; Nasal spray; Subcutaneous injection
DosageTablets: 50-100mg per dose (max 300mg per day)
Nasal spray: 10-20mg per dose (max 40mg per day)
Subcutaneous injection: 6mg per dose (max 12mg per day)
AvailabilityS3 (pharmacist only) for 2 x 50mg tablets; all other dosages S4 (prescription only).
Cost per doseApprox $7-28, depending on dose, brand, pharmacy dispensing fees, etc.
PBS Status?Some doses and formulations are PBS-listed (50mg tablets and 20mg nasal spray), others are only available on private scripts.

Cost and access in Australia

Sumatriptan has been available in Australia since the early 1990s. Currently, it is only available in Australia as an oral tablet or fast disintegrating tablet (as of February 2024). It was previously available as a nasal spray and injection, however these formulations have been discontinued by the manufacturer.

Since March 2021, sumatriptan 50mg tablets are available without a prescription at pharmacies (packets of 2 tablets only). You can learn more about triptans without a prescription in this webinar from Migraine & Headache Awareness Week 2023 – Triptans Without A Prescription (Dr Jacinta Johnson). The 50mg tablets are also accessible by prescription through the Pharmaceutical Benefits Scheme (PBS). The 100mg tablets are prescription-only, however they are not listed on the PBS and are only available privately.

The table below shows the approximate cost for different types of sumatriptan. Please note that the cost could vary depending on many factors such as choice of pharmacy, if you have a concession card, brand, etc.

ProductPrescription needed?Listed on PBS?Approximate cost
2 x 50mg tabletsNoNo$7-10
4 x 50mg tabletsYesYes$10-15
2 x 100mg tabletsYesNo$18

How sumatriptan works

Sumatriptan belongs to a class of drugs called ‘triptans’, which are acute medications developed specifically to treat migraine pain. However, they aren’t ‘painkillers’ in the same way as paracetamol, ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs).

Triptans work by activating your serotonin receptors, specifically the 5-HT1B and 5HT1D receptors (2). This stops two of the processes that occur during a migraine attack:

  • Dilation of blood vessels. Dilated blood vessels contribute towards the pain of a migraine attack. When the 5-HT1B receptor is activated, it helps to constrict (narrow) your blood vessels. 
  • Activation of trigeminovascular system. The trigeminal nerves usually release proinflammatory proteins during a migraine attack, which causes migraine pain. Activation of the 5HT1D receptor stops these proinflammatory proteins from being released.

Sumatriptan and other triptans only work for head pain, and can’t be used to treat other conditions. They also can’t be used to prevent migraine attacks from occurring.

Diagram showing the mechanism of action for sumatriptan, with a graphic of inflammatory proteins being blocked and a graphic of blood vessels being constricted.

Dosage and administration

Of all the triptans, sumatriptan has the greatest flexibility in how it is administered. It can be administered orally in tablet form, as a nasal spray, and by injection.

All forms of the medication are best administered when the migraine attack begins. You should take it when you start to experience head pain (or your most bothersome symptom), because sumatriptan does not work as well if it is taken too early. However, if it is taken after a migraine attack has progressed, it may still help (3).

If you experience nausea and vomiting early in a migraine attack, the nasal spray or injection forms of sumatriptan could be used. The tablet form may not be effective if it cannot be kept down.

If migraine symptoms are not affected by the medication after the first dose, in general you should cease taking it for that migraine attack, though you can use it on another occasion to treat another migraine attack (or cluster headache in the case of the injections). Provided there are no side effects, all sumatriptan formulations can be used to treat at least three separate migraine attacks before it’s decided that sumatriptan is not effective for you (3). 

Oral medication dosages

Oral formulations of sumatriptan are taken whole with water, and can be taken with or without food (3).

The usual starting dose for sumatriptan tablets for people between 18 to 65 years old is 50mg, which can be increased by prescription to 100mg if 50mg does not have any effect. If the first dose of sumatriptan reduces migraine symptoms but later they come back, you can take another dose of sumatriptan so long as you do not take more than 300mg within a 24 hour period.

Nasal spray dosages

The nasal sprays come in single dose vials of two strengths – 10mg or 20mg. Your doctor will prescribe one of these to be taken as a nasal spray when the symptoms of a migraine attack present.

Even though the dose is lower in nasal sprays than it is in a tablet, this does not mean it is any less effective. This formulation of the drug is absorbed faster and more efficiently than tablets, which is why you need less of the active ingredient. Nasal sprays are similar in effectiveness to tablets according to most studies.

If the first dose of sumatriptan reduces migraine symptoms, but later they come back, you can take another dose of sumatriptan so long as you do not take more than 40mg within a 24 hour period.

Injection dosages

There are two sumatriptan subcutaneous injection products available in Australia: a prefilled autoinjector (Imigran Mk II) and a prefilled pen (Clustran). Both the autoinjector and the prefilled pen each contain 6mg of sumatriptan, which is one dose. Similar to nasal sprays, the dose is lower because injections go quickly into your bloodstream, meaning it takes effect almost immediately.

Sumatriptan should be injected just under the skin on the outside of the thigh, and must be administered under the supervision of a doctor the first time. Once they’ve shown you how to do it, you can administer it yourself with the help of the relevant patient instruction leaflets that come with these medications.

A 6mg dose should be injected when symptoms of a migraine attack or cluster headache present. If the first injection of sumatriptan reduces migraine or cluster headache symptoms but later they come back, you can administer another injection so long as:

  • it is at least one hour after the first injection, and
  • you do not use more than 2 injections (2 x 6mg) within a 24 hour period.

How effective is sumatriptan?

Sumatriptan is considered an effective medication for relieving the headache and other symptoms of migraine attack across migraine types, and compares favourably with other medications used for the acute treatment of migraine attacks.

Generic treatments diagram

One study evaluated the efficacy of different types and formats of triptans in a systematic review and meta-analysis (4). The table below shows the results for sumatriptan compared to placebo, paracetamol and non-steroidal anti-inflammatories (NSAIDs).

Medication2-hour headache relief2-hour freedom from painUse of rescue medications
Placebo26.7%10.6%51.6%
25mg tablet44.2%24.9%46.4%
50mg tablet49.7%27.7%33.8%
100mg tablet53.4%32.1%27.4%
Nasal spray52.6%21.2%-
Subcutaneous injection75.7%36.6%23.4%
Paracetamol51.7%22.2%-
NSAIDs48.0%21.8%36.9%

Source: C Cameron et al, 2015, Triptans in the Acute Treatment of Migraine: A Systematic Review and Network Meta-Analysis. DOI: 10.1111/head.12601

If you don’t find sumatriptan effective, try not to be discouraged. Most people with migraine will respond to at least one type of triptan medication, with trials suggesting that it is worth trying other types if the first one doesn’t work (5). Studies have also shown that when a person has a partial response to triptans, combining triptan therapy with NSAID therapy is more effective than taking either medication alone (6).

Side effects: common, serious and very serious

Like most medications, sumatriptan may cause side effects. In most cases, they will be minor and temporary however, more serious complications or reactions are possible that require immediate medical attention. Side effects can also vary depending on your age, other health conditions you have and other medications you take (3).

Common, serious and very serious side effects are summarised below. However, some people may experience side effects that are not listed here. You should always tell your doctor or pharmacist if you notice anything that is making you feel unwell. After receiving medical advice about any side effects that you experience, you or your doctor or neurologist can report them to the Therapeutic Goods Administration.

In addition to the side effects listed below:

  • a common side effect of the injections is temporary pain at the site of the injection (7), and
  • common side effects of the nasal spray are irritation and burning in the nose or throat and nasal bleeding, which, if experienced, you should notify your doctor.

Common side effects (3)

These are common side effects, which are mostly mild and short-lived. If they affect you, don’t do anything that could be dangerous (such as operate machinery if drowsy).

If you experience any of these side effects and they worry you, tell your doctor.

  • pain, tingling, burning, prickling, cold or flushing in any part of the body
  • loss of touch sensitivity
  • drowsiness, feeling of sleepiness, dizziness, weakness or tiredness
  • nausea (feeling sick) or vomiting
  • change in blood pressure
  • feeling of faintness
  • problems with your eyesight or jittery eye movements
  • shaking or tremors, uncontrolled movements

Serious side effects (3)

These are more serious side effects that may need medical attention.

Tell your doctor straight away if you experience them.

  • pain in the lower tummy and bloody diarrhoea (signs of ischemic colitis)
  • breathing problems
  • feeling faint due to a drop in blood pressure

Very serious side effects (3)

These are very serious side effects. If they happen, stop taking sumatriptan and immediately contact your doctor or go to Accident and Emergency at your nearest hospital.

  • signs of an allergic reaction, including:
    • shortness of breath, wheezing or difficulty breathing
    • swelling of the face, lips, tongue, throat or other parts of the body
    • rash, itching or hives on the skin
    • fainting
    • hay fever-like symptoms
  • neck pain or stiffness, feeling of heaviness, pressure or tightness in any part of the body including the head, chest or throat
  • chest pain or angina or symptoms of a heart attack such as chest pain, shortness of breath nausea, vomiting, palpitations, sweating, anxiety
  • fast, slow, thumping or irregular heartbeats
  • seizures (fits)
  • problems with speech, and/or lack of muscle movement on one side of your body (signs of a stroke)
  • persistent purple or white discolouration and/or pain in the fingers, toes, ears, nose or jaw, sometimes in response to cold

Warnings & risks

Medication overuse headache

Sumatriptan is not addictive, but it is associated with medication overuse headache (MOH), a condition caused by consuming too many acute medications used to treat headache. MOH can significantly increase the frequency of migraine attacks and reduce your responsiveness to preventive treatments (3). It can also be difficult and very unpleasant to reverse MOH.

The safe limit for avoiding MOH while on sumatriptan (or any other triptans) is to take the medication no more often than 10 days during any month, or 30 day period.

 

Graphic showing guideline for safe medication usage: Simple analgesics/NSAIDs – 3-4 days per week; Triptans – 1-2 days per week; Ergotamines – never; Codeine – never, or once a month (if necessary); Injected narcotics – once every couple of months (if necessary)

Health conditions that are not appropriate for sumatriptan

All triptans, including sumatriptan, can cause constriction of blood vessels. For that reason, patients with cardiovascular disease should avoid them, including anyone with a history of (3,8):

  • Heart disease
  • Heart attack
  • Angina
  • Prinzmetal’s angina
  • High blood pressure that isn’t controlled by medication
  • High blood cholesterol
  • Stroke or transient ischaemic attack (‘mini-stroke’)
  • Family history of heart disease

Sumatriptan is also not suitable for anyone who is allergic to it, or allergic to other ingredients in the medications, such as lactose or sulphur, which are both in the tablet form of sumatriptan. People with allergies should tell their doctor about all their allergies (including allergies to medicines, foods, preservatives or dyes) and carefully check the ingredients of the specific medication you propose to take. If you experience allergic symptoms while on the medication, you should discontinue it and immediately consult your doctor (3).

Interactions 

Some medicines interact with others, affecting how well they work or putting health at risk. The medications that interact with sumatriptan are in the table below. There may be medications not listed in the table below that also interact with sumatriptan, which is why it is very important that you always tell your doctor and pharmacist about all medications you are taking, including non-prescription medications, natural therapies and vitamins.

The needle of the Imigran Mk II injection has a latex shield, and the vial of the nasal spray is sealed with a rubber stopper, which may cause allergic reactions in people who are sensitive to latex (7). 

Medications that interact with sumatriptan

Medication typeExamplesAction
Monoamine oxidase inhibitors (MAOIs)Eg. phenelzine, tranylcypromine, moclobemide (for depression), selegiline (for Parkinson’s disease), linezolid (for some infections), and methylene blue (used in some diagnostic tests)Do not take sumatriptan with MAOIs or within two weeks after stopping taking a MAOI.
Other triptansEg. naratriptan (Naramig) and zolmitriptan (Zomig)Do not take sumatriptan for 24 hours before or after taking another triptan.
Other medicines for treating migraineEg. ergotamine (Cafergot), dihydroergotamine (DHE, Dihydergot) or methysergide (Deseril)Do not take sumatriptan for 6 hours before or 24 hours after taking ergotamine- type medicines
Medications for treating depression, especially Selective Serotonin Reuptake Inhibitors (SSRIs) or Serotonin- Noradrenaline Reuptake Inhibitors (SNRIs)SSRIs and SNRIs include fluoxetine, paroxetine, fluvoxamine, sertraline, citalopram, venlafaxine, nefazodone, mirtazapineDo not take sumatriptan
Herbal preparations or medications containing St John's wortVarious products. Check ingredients on all therapeutic preparations or medications that you takeDo not take sumatriptan

Storage

All forms of sumatriptan should be kept in their pack until taken and be stored in a cool dry place as heat and dampness can sometimes destroy medicines (3). It’s recommended that Clustran prefilled pens be stored below 25 degrees, and that all other forms of sumatriptan be stored under 30 degrees Celsius (3). The nasal spray vials should also be protected from light.

Further information & resources

If you would like to learn more about migraine or different treatment options, you may find the following articles helpful.

References

  1. M AM Al-Karagholi, 2022, Debate: Are cluster headache and migraine distinct headache disorders?. DOI: 10.1186/s10194-022-01504-x
  2. D W Dodick & V Martin, 2004, Triptans and CNS Side-Effects: pharmacokinetic and metabolic mechanisms. DOI: 10.1111/j.1468-2982.2004.00694.x
  3. Therapeutic Goods Administration, 2023, Product Information (Summary) [for each product containing sumatriptan on the ARTG]. Retrieved from: https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/PICMI?OpenForm&t=pi&q=sumatriptan 
  4. C Cameron et al, 2015, Triptans in the Acute Treatment of Migraine: A Systematic Review and Network Meta-Analysis. DOI: 10.1111/head.12601
  5. B Gilmore & M Michael, 2011, Treatment of Acute Migraine Headache. PMID: 21302868. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/21302868/ 
  6. S Law et al, 2016, Sumatriptan plus naproxen for the treatment of acute migraine attacks in adults. DOI: 10.1002/14651858.CD008541.pub3
  7. Therapeutic Goods Administration, 2003, ARTG ID 44465 [IMIGRAN Mk II sumatriptan 6mg/0.5mL (as succinate) injection syringe (N) Consumer Medicine Information (CMI) Summary]. Retrieved from: https://www.tga.gov.au/resources/artg/44465 
  8. B Jenkins, 2020, Migraine management. DOI: 10.18773/austprescr.2020.047
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