Acute Medicines

Acute Medicines - Nasal Sprays

Introduction

Triptans (also known as serotonin 5-HT 1B/1D receptor agonists) relieve migraine pain by affecting neurotransmitters and pain pathways in the brain. They also relieve other migraine symptoms such as nausea/vomiting and sensitivity to light/sound. Some triptans are formulated as nasal sprays in addition to oral tablets and injection. Nasal sprays are generally absorbed faster into the bloodstream because they bypass the stomach area. During a migraine attack, the digestive system slows down which may result in slower absorption of oral tablets. Nasal sprays may also be useful if a patent is suffering from nausea and/or vomiting, making it difficult to take oral tablets. As with oral and injectable triptans, patients should not use nasal triptans if they have a history of heart problems or uncontrolled high blood pressure.

Dihydroergotamine, an ergot derivative, is also available as a nasal spray (in addition to injection).

Oral medications—like pills and tablets—are absorbed into your blood by your digestive system. But in some people, the digestive system slows down during a migraine. This may affect how a drug is absorbed. 1,2

Remember that all medications produce side effects, so it is very important to openly discuss any medicines (even over-the-counter or herbal products) that are being used to treat headaches. If these medications are taken too often, this can result in chronic headaches (medication overuse headache). There is also potential for drug interactions with herbal or over-the-counter medicines.

Sumatriptan (Imitrex® and generic)

Sumatriptan belongs to a class of drugs known as triptans. It affects a certain natural substance (serotonin) that causes narrowing of blood vessels in the brain. It may also relieve pain by affecting certain nerves in the brain. 1

Sumatriptan nasal spray is used to treat acute migraine headaches with or without aura in adults. According to Dr. Elizabeth Leroux (Headache Neurologist, Montreal, Quebec) sumatriptan nasal spray has Level B evidence 2 for the treatment of cluster headaches. This finding was published in the American Headache Society guidelines in 2016.

Sumatriptan works in the brain to relieve the pain from migraine headaches. It belongs to the group of medicines called triptans. 2

Many people find that their headaches go away completely after they use sumatriptan. Other people find that their headaches are much less painful, and that they are able to go back to their normal activities even though their headaches are not completely gone. Like other triptans, sumatriptan often relieves other symptoms that occur together with a migraine headache, such as nausea, vomiting, sensitivity to light, and sensitivity to sound. 2

The nasal spray contains 5mg of this drug, are contained in each spray.

Side effects include: unusual taste in the throat or mouth, tingling sensations, weakness or dizziness, etc.

Zolmitriptan (Zomig®)

Zolmitriptan (Zomig), also comes in the form of as nasal spray. The nasal spray gets partially absorbed in the nasal passageway and has a very fast onset of action (about 15 minutes).

The dose of Zomig® is either 2.5 or 5mg. Your doctor will determine which dose is right for you.

As with other nasal sprays, migraine patients with as history of heart problems, including chest tightness should not take Zomig nasal spray. Side effects are generally rare but can include: dizziness, weakness, drowsiness, and fatigue. Visit the Zomig link to view a list of all potential side effects. 3

Click here to learn more about Zomig

Dihydroergotamine (Migranal®)

Dihydroergotamine is an ergot alkaloid used to treat migraines. It is a derivative of ergotamine. It is administered as a nasal spray or injection and has an efficacy similar to that of sumatriptan. 4

Migranal® (dihydroergotamine mesylate, USP) Nasal Spray is used to treat an active migraine headache with or without aura. Do not use it to try to prevent a migraine if you have no symptoms, to treat a common tension headache, or to treat a migraine that is not typical of your usual migraine. 5

Dihydroergotamine, in nasal spray form or as an injection (given in hospital usually), has fewer side effects than ergotamine and can be very effective for migraine, especially if it is a prolonged attack. 6

Migranal® nasal sprays contain 4mg of DHE. On the Migranal® website, there is a downloadable step-by-step instructional guide.

Side effects include sore nose/throat, stuffy nose, changes in taste, dizziness, or nausea.

Click here for more information on Migranal

Nasal sprays are often prescribed if vomiting is a factor with the migraine sufferer.

Patient Support Programs (PSP)

Patient support programs (PSPs) are usually sponsored by pharmaceutical companies and provide free or discounted medicines to low income or uninsured and under-insured people who meet specific guidelines. Eligibility requirements vary for each program. 7

Medical edits courtesy of Irene Worthington, B.Sc.Phm (co-author of Canadian acute and prophylactic migraine guidelines). Pharmacist (retired) Sunnybrook Hospital, Toronto, Ontario

REFERENCES

1. WebMD - Imitrex Nasal Spray
2. Imitex Nasal Spray - Mayo Clinic
3. www.zomig.com/what-is-zomig-nasal-spray/
4. Wikipedia - Migranal
5. Migranal.com
6. Dihdroergotamine - Chronic Daily Headache 2013
7. Patient Support Programs - Drugs.com