Migraine abortive drugs called triptans can cause the potentially serious serotonin syndrome in rare cases, according to a study in the May 15 issue of the New England Journal of Medicine. Serotonin syndrome is a known risk when combining antidepressants and triptans. The new study shows that triptans alone can cause serotonin syndrome.
Serotonin syndrome is most likely to happen when you first start taking the medication. It is very rare and, even if it does happen, the remedy is to stop taking the medication. According to Migraine Medications May Cause ‘Serotonin Syndrome’ in the Washington Post:
The average age for someone experiencing serotonin syndrome associated only with triptan therapy was 39.9 years, and the most common symptoms included tremor, stiffness, palpitations, high blood pressure and agitation, according to the study.
Five people required hospitalization, and two cases were classified as “life-threatening.” Four of the 11 cases cleared up within an hour of treatment.
“It’s very rare and not likely to happen,” said Soldin of serotonin syndrome. “And, you just need to stop taking the drugs when it does happen. If you’re taking these medications and you have strange muscular, mental or hyperactivity symptoms, contact your doctor.”
Not sure if you’re taking a triptan? The seven available are:
- Imitrex or Imigran (sumatriptan)
- Maxalt (rizatriptan)
- Amerge or Naramig (naratriptan)
- Zomig (zolmitriptan)
- Relpax (eletriptan)
- Axert or Almogran (almotriptan)
- Frova or Migard (frovatriptan)
Read more about serotonin syndrome in these posts:
Anyone who has been diagnosed with migraine without being told about triptans has been done a disservice. In my non-medical opinion, unless a person has an underlying medical condition that would making the medication dangerous, like stroke, uncontrolled diabetes, high blood pressure or heart disease, they should try at least one triptan.
The gold standard migraine abortive, triptans can work like magic for some migraineurs. They don’t work for everyone, but are helpful for many and can abort the migraine entirely before it begins. For others, the effect isn’t miraculous, but the reduction in intensity or severity of their migraines is still significant. It’s also worth noting that a lot of people have to try several different triptans to find the one that works for them.
There are seven different triptans. Imitrex was the first on the market and is the one people are most likely to know about. The others are Amerge, Axert, Frova, Maxalt, Relpax and Zomig. If you can’t keep a pill down, some are available as injections, suppositories and nasal sprays. Remember, though, that even triptans can cause rebound headaches.
To learn more about the drugs and how they work, see WebMD’s terrific article.
A study published in the July/August issue of Headache found strong support for trying a different triptan if the first brand you tried didn’t give you sufficient relief. Researchers recruited migraineurs who weren’t helped by Imitrex (sumatriptan), and gave them Axert (almotriptan) or a placebo to take at the onset of their next migraines. 47% of participants in the Axert group experienced pain relief at the two hour mark of the migraine, whereas 24% of the placebo group did.
The authors say that they weren’t surprised by the results because “migraine patients are not all the same, migraine headaches are not all the same and triptans are not all the same.” Triptans differ enough to have different side effects too. A real-life example is that Imitrex made my husband, who has migraines about 8 times a year, violently ill. When he finally got over his Imitrex induced aversion to triptans, he tried Axert, which didn’t make him nauseous.
Switching Triptans May Improve Migraine Response is the Reuters article published about the study. The journal article abstract is also available.