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.
