Oral vs. Injectable Triptans: What to Know About These Fast-Acting Migraine Medications

Migraines are painful headaches that have varying symptoms and durations. But they all have something in common — they can be debilitating.

To manage migraines, many people start with lifestyle changes and natural remedies. Others take over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or Excedrin (acetaminophen / aspirin / caffeine), to treat the pain when migraines occur. But these options may not always be enough. In some cases, you may need to bring out the heavy-hitters.

There are several options to treat moderate-to-severe migraines, with the most common being a class of medications called triptans. Triptans act fast to treat migraines, and they come in different formulations. Here, we’ll review how to take oral versus injectable triptans and what to expect from each type.

What are triptan migraine medications?

Triptans are first-choice prescription medications for treating migraines. They attach to serotonin receptors (chemical binding sites) in your brain, which causes widened blood vessels to tighten. This helps lower the pain and swelling that usually come with migraines.

All triptans treat migraines using the same strategy. They’re all similarly effective, too. But they aren’t one in the same. There are seven different triptans, and they each come in different formulations. These include oral pills, injectables, and nasal products.

You can work with your healthcare provider to pick the right triptan for you, based on your medical history and preferences, and the medications’ possible side effects.

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How to take triptans for migraines

Migraine experts say it’s best to take your triptan right as your migraine pain starts — before the pain gets very strong. If you wait too long, it might not work as well. And for most triptans, you can take a second dose if you still need additional pain relief. But you have to wait a specified amount of time between your first and second dose, based on the type of triptan, which is described below.

You shouldn’t take triptans every day, though. They’re designed to only be taken as needed, up to 10 times per month. Overusing them can lead to rebound headaches.

All triptans have their own nuances, too. Oral triptans are different from injectable triptans. And both of these are different from nasal triptans.

Oral triptans

All seven triptans are available as oral tablets. Most of them are available in both generic and brand formulations:

• Sumatriptan (Imitrex)

• Zolmitriptan (Zomig)

• Rizatriptan (Maxalt)

• Eletriptan (Relpax)

• Frovatriptan (Frova)

• Naratriptan

• Almotriptan

Specific doses vary, but you should take one tablet by mouth when you first feel your migraine pain. For most triptan oral tablets, you can take a second dose — if needed — at least 2 hours after the first dose. The one exception is for naratriptan; you should wait at least 4 hours after the first dose to take a second dose.

Orally disintegrating tablets (ODTs) are another choice. You can place an ODT on or under your tongue and let it dissolve instead of swallowing it whole. Of the triptans, only zolmitriptan (Zomig-ZMT) and rizatriptan (Maxalt-MLT) are available as ODTs.

Injectable triptans

Sumatriptan (Imitrex STATdose, Zembrace SymTouch) is the only triptan available as an injection. It’s injected just under the skin. This is a good option if you have difficulty swallowing tablets or are experiencing severe nausea with your migraine.

For the sumatriptan injection, you can administer a second dose at least 1 hour after your first dose, if it’s needed.

Keep in mind: It’s important to note that the two sumatriptan injection devices work differently. Talk to your pharmacist about the right way to use yours.

What other triptan dosage forms are available?

Sumatriptan (Imitrex, Tosymra) and zolmitriptan are also both available as nasal sprays. You can spray either medication into an open nostril right when your migraine starts.

Sumatriptan also comes as a nasal powder called Onzetra Xsail. This is different from the nasal spray — the powder comes inside a capsule and is meant to be delivered through the nose. Onzetra Xsail’s instructions will show you how to use the delivery device to properly inhale the powder. 

Both the nasal spray and nasal powder are good options for people who can’t swallow pills but want to avoid injections. You can administer second doses at least 2 hours after the first dose if you still have symptoms.

The different formulations of the seven triptans are summarized here:

Do oral and injectable triptans work immediately?

Oral and injectable triptans both start working quickly. But injectable sumatriptan works faster than oral triptans. The injectables generally kick in within about 10 minutes.

Of the oral tablets, rizatriptan is the fastest to work. It starts working within about 30 minutes, but its effects wear off the fastest. It may be the best option when your migraines come on quickly. The other oral triptans take longer than 30 minutes to start working. Frovatriptan’s effects last the longest, so it may be the best option if your migraines tend to linger.

What’s more, ODT and regular oral tablets start working at similar speeds. But people in some clinical trials preferred the ODT formulation over the oral tablet for convenience’s sake.

Nasal sprays also start working faster than oral formulations — within about 15 minutes — but their effects don’t last as long.

Some people keep multiple triptans on hand to manage their migraines better, too. For instance, your healthcare provider may suggest using a nasal spray or injection first, since you will feel their relief faster, and then taking an oral tablet a few hours later if you continue to have symptoms. Talk to your healthcare provider to find out if this type of combination strategy is right for you.

Do different triptans have different side effects to be aware of?

Yes. General triptan side effects include flushing, chest tightness, and feeling “pins and needles” sensations. But different formulations have varying side effects.

The sumatriptan injection can also cause pain, redness, and swelling at the spot where you administered the injection. 

Meanwhile, the nasal spray formulations may also cause burning in the nose, throat irritation, and changes in taste. The sumatriptan nasal powder can cause temporary irritation in the nose and throat.

How to save on triptans

There are many ways to save on triptan medications. GoodRx can help you navigate your options, which may include GoodRx discounts, copay savings cards, and patient assistance programs. You can find triptan prices as low as $14 with a free GoodRx discount. Specific prices vary by medication, quantity, and dosage form.

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Written by:

Hindu Rao, PharmD, APh, BCACP

Hindu Rao, PharmD, APh, BCACP is a clinical assistant professor of pharmacy practice at Chapman University School of Pharmacy and a clinical pharmacist at Providence Medical Foundation. She specializes in chronic disease management and has her board certification in ambulatory care.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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