Tripping on Triptans
Mechanism of action
What is 5-HT1B,D?
These mu receptor agonists have been frequently used but are not shown be effective in migraine treatment
What is an opioid?
I betchu you have this in your medicine cabinet (even if you may not understand how it works)
What is tylenol?
Triptans should administered at this time course of the migraine
What is as early as possible?
This first generation antipsychotic and antiemetic has level A evidence suggesting ED's must offer it
What is prochlorperazine/compazine?
Headache all-comers this should be your first line of defense (UNLESS YOU HAVE KIDNEY PROBLEMS)
What are NSAIDs?
Contraindications (name 2)
What are HTN, TIA, PAD, high ICP?
Your patient has a migraine and has treated it at home, you give them the cocktail, and now they are hot and hyperreflexive with this adverse effect
What is serotonin syndrome?
Based on 2025 guidelines, this outpatient therapy has the strongest recommendation, since it is shown to be superior to triptans, NSAIDs, or Tylenol/APAP alone.
What is combination therapy?
Triptans AND NSAIDs
Triptains AND Tylenol
Side effects (name one minor and one major)
What are minor: chest pressure, flushing, nausea, dizziness major: serotonin syndrome, stroke, ischemic colitis, spinal cord infarction?
Monoclonal antibodies to this receptor are typically used for prevention, but some formulations have shown benefit in acute settings.
What is CGRP?
For the fastest relief at home, sumatriptan can be given this way, working in as little as 10 to 15 minutes. You are a speed demon.
What is a self-subcutaneous injection?
Similar drugs that are selective 5-HT1F agonists
What are Ditans?
This ergot derivative can’t be given within 24 hours of a triptan. Its repeated IV use in the hospital is known as the Raskin protocol
What is dihydroergotamine (DHE)?
This class of acute migraine drugs blocks the CGRP receptor and, unlike triptans, doesn’t constrict blood vessels.
What are gepants?
New in 2025! For an acute migraine, EDs should offer a local anesthetic block to the occipital nerve, originating from these nerve roots.
What is C2 (and C3)?