Part of the Access Doctor migraine treatment guide. Conditions overview: migraine & headache UK.
Triptans for Migraine UK: Sumatriptan vs Rizatriptan vs Zolmitriptan
A clinically reviewed comparison of the three triptans prescribable in the UK — how they work, dosing, onset of action, available forms, propranolol interactions, and which to choose.
▶ Triptans at a glance
Triptans (5-HT1B/1D receptor agonists) are the most effective prescription treatment for moderate to severe migraine. Three are prescribable in the UK: sumatriptan (most studied), rizatriptan (fastest onset, highest oral bioavailability), and zolmitriptan (also available as nasal spray and wafer). Around 60% of patients achieve headache relief at 2 hours with their optimal triptan; the pain-free rate at 2 hours is approximately 25–35%. GPhC pharmacy #9011198.
3
Triptans prescribable by Access Doctor
~45%
Rizatriptan oral bioavailability (vs ~14% sumatriptan)
30m
Rizatriptan onset; 30–60m sumatriptan
~60%
Patients achieve headache relief at 2 hours with triptans (pain-free rate is ~25–35%)
How Triptans Work
All triptans are 5-HT1B/1D receptor agonists. They work by two mechanisms that specifically target the migraine attack:
- Cranial vasoconstriction — constricts dilated intracranial blood vessels that contribute to migraine pain
- Trigeminal pathway inhibition — blocks the release of inflammatory neuropeptides (CGRP, substance P) from trigeminal nerve terminals, interrupting the pain signal at source
Triptans do not work for tension headache, cluster headache, or other non-migraine head pain. They are migraine-specific treatments.
Triptans should be taken at headache onset — not during the aura phase. Early treatment during the headache phase (before pain becomes severe) produces the best response rates.
Sumatriptan vs Rizatriptan vs Zolmitriptan
| Property | Sumatriptan | Rizatriptan | Zolmitriptan |
|---|---|---|---|
| Brand name / Buy | Sumatriptan · Imigran nasal spray | Rizatriptan ODT · Maxalt Melt | Zolmitriptan · Zomig spray |
| Standard oral dose | 50mg (100mg available) | 10mg (5mg with propranolol) | 2.5mg |
| Oral bioavailability | ~14% | ~45% | ~40% |
| Onset of action | 30–60 minutes | ~30 minutes | ~45 minutes |
| Available forms (UK) | Oral tablet, nasal spray, injection | Oral tablet, wafer (Maxalt Melt) | Oral tablet, nasal spray, wafer |
| Propranolol interaction | Standard dose usable | Use 5mg not 10mg | Dose reduction may be needed |
| Evidence base | Largest — most studied | Strong — superior bioavailability | Strong — also available as nasal spray |
Wafer formulations: Rizatriptan Maxalt Melt and zolmitriptan Zomig wafer dissolve on the tongue without water. These are particularly useful during migraine attacks when nausea makes swallowing difficult.
Which Triptan Should You Choose?
All three triptans listed below are effective. Almotriptan 12.5mg is also available at Access Doctor — a well-tolerated alternative triptan. The best choice depends on individual response, speed of onset preference, nausea severity, and whether propranolol is co-prescribed.
| If you... | Consider |
|---|---|
| Want the most widely prescribed, best-evidenced option | Sumatriptan 50mg — first choice for most patients |
| Want faster onset and higher bioavailability | Rizatriptan 10mg — typically 30-minute onset |
| Have difficulty swallowing tablets during an attack | Rizatriptan Maxalt Melt or Zolmitriptan wafer — dissolve on tongue |
| Take propranolol for migraine prevention | Sumatriptan (standard dose usable) or Rizatriptan 5mg |
| Sumatriptan has been ineffective | Try Rizatriptan or Zolmitriptan — response varies between individuals |
What to Do If Triptans Are Not Working
If one triptan is ineffective, trying an alternative triptan is clinically reasonable — individual response varies considerably. Other approaches include:
- Combining with naproxen 500mg — naproxen + triptan is superior to either alone
- Adding an anti-emetic (prochlorperazine) to improve absorption and treat nausea
- Using a faster or non-oral formulation (injection or nasal spray for sumatriptan/zolmitriptan)
- Considering preventive treatment if attacks are frequent — see migraine prevention guide
Get a Triptan Prescribed Online
Our GPhC-registered pharmacist independent prescribers can assess your suitability for sumatriptan, rizatriptan or zolmitriptan. Discreet next-day delivery. GPhC pharmacy #9011198.
Request Triptan Prescription →Frequently Asked Questions
What is the best triptan for migraine?
There is no single best triptan — response varies between individuals. Sumatriptan 50mg is the most widely prescribed first-line option. Rizatriptan offers higher bioavailability and faster onset. If one triptan is not effective, switching to another is clinically reasonable. Your prescriber will guide the choice.
Can I take a triptan and naproxen together?
Yes. Combining a triptan with naproxen 500mg produces better migraine relief than either drug alone. This combination addresses both the vascular (triptan) and inflammatory (NSAID) components of the attack.
How quickly do triptans work?
Rizatriptan has the fastest onset at approximately 30 minutes. Sumatriptan tablets take 30–60 minutes. Sumatriptan subcutaneous injection works in 10–15 minutes and is the fastest option for severe attacks.
Can I take triptans every day?
No. Triptans should not be used on more than 10 days per month. Using them more frequently risks medication overuse headache (MOH), which paradoxically worsens headache frequency. If you need acute treatment this frequently, preventive therapy should be considered.
Do triptans work for all types of headache?
No. Triptans are migraine-specific and work by targeting migraine pathophysiology. They are not effective for tension headache, cluster headache, or other non-migraine head pain. Using them for non-migraine headache will not provide benefit and increases overuse risk.
References
- NICE. Headaches in over 12s: diagnosis and management. CG150. 2012 (updated 2021).
- Ferrari MD et al. Oral triptans in acute migraine treatment: a meta-analysis of 53 trials. Lancet. 2001.
- NHS. Sumatriptan. nhs.uk/medicines/sumatriptan
Medical disclaimer: This article is for informational purposes only. Prescription migraine treatments require a clinical consultation. Always consult a qualified healthcare professional. In a medical emergency, call 999.