Zolmitriptan, also known by the brand name Zomig, is a medication to treat acute migraine attacks. It belongs to a class of medications known as the triptans and is an agonist of a subset of serotonin receptors. These receptors are found on neurons and blood vessels of the brain. When Zolmitriptan binds blood vessels it causes constriction and alleviates swelling in the brain, relieving the pain in a migraine. By binding neurons, it reduces pain transmission, reduces nausea and inhibits the release of inflammatory mediators. Sensitivity to light and sound are also reduced.
When should Zolmitriptan be taken?
Zolmitriptan should be taken when first symptoms of a migraine are developing. As the migraine unfolds it will help to ease symptoms. However, zolmitriptan does not prevent migraines from occurring or reduce the frequency of migraine attacks.
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Which types of migraine is Zolmitriptan suitable for?
A migraine with or without aura can be treated with Zolmitriptan however it should be noted that basilar migraines and hemiplegic migraines should not be treated with this medication.
Who can take Zolmitriptan?
Certain patient groups should not be taking Zolmitriptan, others need to talk to their doctor regarding their conditions.
Avoid Zolmitriptan if any of the following apply to you:
- Heart disease, coronary artery vasospasm
- Diseases with accessory conduction pathways in the heart
- Stroke or TIA (mini-stroke)
- Peripheral vascular disease
- Ischaemic bowel disease
- A previous reaction to the medication
- Recent use (24h) of another serotonin receptor agonist or triptan
- Use of ergotamine containing medication
- Use of MAO-I within the last 2 weeks
Discuss with a doctor if the following conditions apply to you:
- High cholesterol
- SSRI/SNRI use
- Liver disease
- High BMI
- History of cardiac or vascular problems
- Past menopause
- Taking herbal medicines
How can I take Zolmitriptan?
Zolmitriptan was first marketed in 1997 as a tablet. Since then an orally dissolving tablet and a nasal spray have also become available.
The tablet comes as 2.5mg or 5mg. It is possible to break the 2.5mg tablets along a central line, however the dissolving tablets should not be split. Take at the first sign of a migraine with a drink of water. If the migraine improves but then worsens after 2 hours (note 2 hours must pass), then a second dose may be taken. The maximum dose over 24h is 10mg.
If you are taking orodispersible tablets these are designed to dissolve on your tongue rather than to be swallowed. Peel open the foil packaging and take a tablet and place it on your tongue. Let it dissolve before you swallow. Similar to the normal tablets you need to wait at least 2h before you take a second dose if symptoms are not improving.
The nasal spray administers single doses of 2.5mg or 5mg. To use the spray remove the protective cover. Block the other nostril, pressing on it with your finger and squeeze the plunger to release the dose into one of your nostrils while breathing in through this nostril.
A second spray after 2h is permissible if symptoms do not improve. Once again 10mg should not be exceeded over 24h.
Side effects, how to tackle these and when to talk to a doctor
The most common side effects, affecting less than 1 in 10 people are the following:
- Feeling nauseous or vomiting - stick to simpler foods
- Feeling dizzy, lethargic or sleepy - do not drive or use machinery
- Tightness in the chest/ throat or feeling heavy - if serious contact your doctor as soon as possible. Do not take further doses
- Palpitations, tingling, feeling achy, weak, dry mouth - contact your doctor
- Unpleasant taste (using nasal spray) - this is usually temporary
Call your doctor promptly if the following apply:
- Tightness, pain, pressure, heaviness in chest, throat, neck or jaw
- Shortness of breath/ wheezing
- Acute or intense stomach pain
- Skin reactions
- Difficulty seeing
- Concerning weakness or numbness
A migraine diary keeping track of when, where, duration, what you were doing, what you had eaten and other factors for 8 weeks will help to establish patterns in what triggers your migraine attacks. By eliminating these one-by-one you can figure out what may be causing your migraines and hopefully avoid them.
As aforementioned Zolmitriptan will ease pain once a migraine has started only. Talk to your doctor about other medications that may help to reduce the number of migraine attacks you have if this is often and troublesome.
If you use painkillers or triptans on more than 2 days a week regularly you may in fact be at risk of medication-induced headaches. Speak to your doctor if this may be the case.