This page has been updated. This page will automatically redirect to the new site or click the following link to go there now: http://www.bellaireneurology.com/headaches/migr_rwtreatments.html

There is a web page on Imitrex® featured on this web site for 2 principle reasons. First, it was the first approved triptan that ushered in a remarkably better form of migraine headache care. Second, it was involved with my own recognition of migraine headaches and treatment. I do not mean by including this page that the oral version of this triptan is superior to any other oral triptan.

Sumatriptan, or Imitrex®, is the medication that changed the lives of migraine patients forever. I can still recall being in my first month or two of neurology residency. I had felt somewhat queasy all day. I was on call and lying in bed at around midnight having recently admitted a patient. My head was pounding and I did not want to move. I was thinking whether I should have a CT scan of my brain as this was clearly the worst headache of my life. At that time, the VA did not have anyone in the hospital to run the CT scanner and the technician had to be called in. I therefore decided (irrationally I might add), that if I had to call in the CT technician for a scan that night that I would also get a scan of my own head (assuming the tech would do it). Despite knowing what I knew about the proper evaluation of the worst headache of one's life, I really was thinking that I really hoped I was not called to the ER to see a patient because I felt so bad and did not want to move. I fell asleep and when I awoke in the morning, headache now gone, I thought, "You idiot, you have migraines." At that time only the Imitrex injection was available. It was a life saver, and probably a residency saver, for me.

The Imitrex injection is still the fastest treatment available to treat migraine headaches. Virtually all patients who tried it found it superior to their prior therapy. Unlike other treatments that were available at the time, the injection sedated few patients. You were actually able to treat your disabling headache and return to work in a matter of minutes. Also, the nausea, light and noise sensitivity went away. Despite the inconvenience of the injection system at the time, few patients complained of any side effects or the difficulty of carrying the injector. Later, the tablet became available. Even though the tablet did not work as well, its convenience, decreased cost, and fewer side effects quickly swept the market. It is important to note that there are some patients who respond to the injection who do not respond to the tablets.

As patients do not like injections, the nasal spray formulation was developed. The nasal spray is a little faster than the tablet but its primary advantage is in those patients that vomit with their migraines and do not want to take an injection.

Imitrex injections are also very useful in cluster headache. This is a very severe and very brief headache that can be severe enough to drive patients to suicide.

I personally feel the injections are underused by most physicians. Studies have shown that patients enjoy using the injection both as a backup to their imitrex tablet and for the occasional severe migraine when they need the extra speed.

I do not want to imply by this page that oral sumatriptan is any better than any of the other fast acting oral triptans, Zomig®, Maxalt®, Axert®, or Relpax®. In fact, no fast acting oral triptan is superior than any other. You can learn more about this on the migraine attack page.