When a migraine happens, many patients reach for common analgesics such as paracetamol and ibuprofen, or combination products containing codeine such as co-codamol or Migraleve. Sumatriptan is a medication that can be used to relieve an acute migraine attack. Sumatriptan works differently to analgesics. In this post, I will discuss the mechanism of action, suitability & requirements for the supply and possible side effects of sumatriptan over the counter.
Sumatriptan mechanism of action?
As the name suggests sumatriptan belongs to a group of drugs called ‘triptans’. Sumatriptan acts on serotonin receptors located in the brain. The main mechanism of action of triptans is constriction (narrowing) of the blood vessels in the brain to counteract dilation which causes the migraine headache. Other mechanisms of triptans are known, however, the description of these is beyond the scope of this post.
Triptans have a fast onset of action and target the areas involved in migraines development with great precision (affinity) allowing good effectiveness in symptom relief, with a low occurrence of side effects (Tepper et al, 2002).
What brand of sumatriptan over the counter can be purchased from the pharmacy?
The following brands of sumatriptan are available in the UK:
- Migraitan 50mg tablets
- Imigran Recovery 50mg tablets
- Boots Migraine Relief 50 mg Tablets
All of the above products are pharmacy only medicines, sold under the supervision of a pharmacist. Each product contains two sumatriptan 50mg tables.
Sumatriptan over the counter requirements
Sumatriptan over the counter is licensed for adults aged 18-65 in treatment of acute symptoms of migraines. Sumatriptan is not taken to prevent a migraine attack. Patients requesting a supply of sumatriptan from the pharmacy are usually asked to complete a health questionnaire to help to confirm that:
- Age is appropriate
- The patient is not pregnant or breastfeeding
- The patient had more than 4 migraine attacks in the past and the first one happened more than a year ago
- The patient was diagnosed with migraines by a doctor and had been previously prescribed triptans or other prophylactic medication
- Diagnosis by a doctor is not required, patients can answer further questions to help pharmacist to confirm a migraine diagnosis
Additionally, patients are asked about:
- frequency, the duration, and symptoms they experience during a migraine attack
- medication being taken
Lastly, the patient requesting sumatriptan over the counter will need to answer questions to assess cardiovascular risk:
- Weight & BMI
- Family history of heart disease
- Any medical conditions increasing cardiovascular risk such as diabetes or high cholesterol
- Smoking status
Sumatriptan should only be used where a clear diagnosis of migraines has been made by a doctor or pharmacist.
How to take sumatriptan over the counter
One tablet should be taken as soon as possible after the first signs of a migraine.
An additional tablet can be taken only if symptoms go away and come back. Additional sumatriptan tablet should not be taken if patients did not get any relief from the first dose. Patients should not take more than 2 tablets in 24 hours.
Sumatriptan possible side effects
Common side effects of sumatriptan include (EMC, 2019):
- Drowsiness, dizziness and sensory disturbance
- Temporary increase in blood pressure & flushing after taking the medication
- Dyspnoea (shortness of breath or breathlessness)
- Nausea and vomiting
- Sensations of heaviness, tightness or pain in the chest or throat (should not last more than 2 hours)
- Pain, sensations of heat or cold (can affect any part of the body)
- Feelings of weakness, fatigue
To read more about other possible side effects and important information regarding sumatriptan, read the product information leaflet. EMC website provides product information leaflets for all licensed medicines, including sumatriptan.
Additional information on migraine symptoms and management can be found on the NHS website.
EMC (2019). Migraitan 50mg Film-coated Tablets: undesirable effects. Available at: https://www.medicines.org.uk/emc/product/3463/smpc Accessed on 10/07/2019
Tepper SJ, Rapoport AM, Sheftell FD. Mechanisms of Action of the 5-HT1B/1D Receptor Agonists. Arch Neurol. 2002;59(7):1084–1088. doi:10.1001/archneur.59.7.1084 Available at: https://jamanetwork.com/journals/jamaneurology/fullarticle/782346 Accessed on 08/07/2019