The triptans have now been available for over ten years, the initial agent being sumatriptan.  There are now six other triptans with varying forms including oral dosing, subcutaneous injection, nasal spray, and rapid oral disintegrating tablets. (Table 15) 

Table 15.  Triptans

Drug	Trade Name	Dose
Sumatriptan	Imitrex	25 mg p.o., 50 mg p.o., 100 mg p.o., and 6 mg sc
Zolmitriptan	Zomig	2.5 mg, 5 mg  (an oral melting tablet is also available)
Naratriptan	Amerge	2.5 mg p.o.
Rizatriptan	MaxAlt	5 mg p.o., 10 mg p.o.  (an oral melting tablet is also available)
Eletriptan	Relpax	40 mg p.o.
Almotriptan	Axert	12.5 mg p.o.
Frovatriptan	Frova	2.5 mg p.o.

As noted by Goadsby,¹⁶ when compared to the ergot medications, the triptans have significant advantages— notably, very selective pharmacology, simple and consistent pharmacokinetics, and established efficacy based on well-designed controlled trials and a well-established safety record.^260,261  The triptans are serotonin 5-HT_1b/1D-receptor agonists.  It is believed this agonist activity is the primary mechanism of the therapeutic effect of the drugs which have three potential mechanisms of action:  cranial vasoconstriction, peripheral neuronal inhibition, and inhibition of transmission through second-order neurons in the trigeminocervical complex.^16,262  Specific contraindications to the use of the triptans include ischemic heart disease, sustained hypertension, Prinzmetal’s angina, and hemiplegic and basilar-type migraine.  Side effects of the triptans include:  tingling, parasthesias, and sensations of warmth in the head, neck, chest and limbs.  There are less frequent side effects such as:  dizziness, flushing, and neck pain or stiffness.  It should be noted that triptans can constrict coronary arteries and can cause chest symptoms which may mimmick angina.  There has been extensive use of the triptans and they are regarded generally as being quite safe, however, they all are 5-HT_1b/1D agonists and these receptors are present on the coronary arteries, thus it is quite reasonable to avoid the use of triptans in ischemic heart disease, uncontrolled hypertension, and cerebrovascular disease. 

Comparisons between the main pharmacologic and clinical characteristics of newer oral triptans compared to 100 mg of oral sumatriptan are reviewed elsewhere.^16,263  In other comparative trials, eletriptan 40 mg was found to be superior to sumatriptan 100 mg.^264,265   In selecting the initial treatment for an acute attack, it should be recognized that migraine is a polygenetic heterogeneous disorder and, therefore, treatment of the initial attacks depend upon the severity and frequency of the attacks and the prior history of treatment.  Patients who do not respond to one triptan may respond to another.  In patients with significant disability, a triptan should be prescribed early in the course of treatment in keeping with a stratified approach to care.^16,266