When a migraine hits, you don’t just want relief-you want it fast, safely, and without making you feel worse than the headache. For years, triptans were the go-to. But now, newer options like gepants and ditans are changing the game. The question isn’t just which one works-it’s which one you can actually tolerate.
Triptans: Fast, But Not for Everyone
Triptans like sumatriptan, rizatriptan, and almotriptan have been around since the 1990s. They work fast-often cutting pain in half within an hour. That’s why they’re still used in over 60% of migraine cases. But their speed comes with a cost.Up to 15% of people feel tingling, flushing, or a strange tightness in the chest. It’s not a heart attack, but it feels like one. That’s because triptans activate serotonin receptors that narrow blood vessels, including those in the heart and brain. For most healthy people, this is fine. But if you have high blood pressure, heart disease, a history of stroke, or even uncontrolled migraines with aura, doctors won’t prescribe them.
Subcutaneous sumatriptan causes injection-site pain in 40% of users. Nasal sprays leave a bitter aftertaste for about a quarter of people. Fatigue and dizziness are common too. One user on Drugs.com wrote: "Experienced severe chest pressure with first dose of Imitrex-never using it again." That’s not rare. About half of people who try triptans eventually stop because of side effects.
Some triptans are gentler than others. Almotriptan and frovatriptan have fewer side effects in clinical trials. Still, if you’re worried about your heart, this class isn’t worth the risk.
Gepants: The Quiet Contender
Gepants-like ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT)-are newer. They block a protein called CGRP, which plays a big role in migraine pain. Unlike triptans, they don’t tighten blood vessels. That makes them safe for people with heart conditions.Side effects? Minimal. Nausea happens in about 5% of users. Drowsiness affects 2-4%. One person on Drugs.com said: "No chest pressure like with triptans, just takes longer to work." That’s the trade-off. Triptans work in 30 minutes. Gepants take 60-90 minutes. But they last longer-up to 48 hours in some cases.
There’s one catch: rimegepant can interact with strong liver enzymes. If you’re on ketoconazole or other strong CYP3A4 inhibitors, your body can’t clear rimegepant properly. That’s rare, but worth checking with your pharmacist.
They’re not perfect. Some people report mild dizziness or dry mouth. But compared to triptans, the safety profile is far better. That’s why prescriptions for gepants jumped from 2% of migraine treatments in 2020 to 28% by late 2023. Doctors now recommend them as a first choice for people with cardiovascular risks.
Ditans: Effective, But Too Sedating
Lasmiditan (Reyvow) is the only ditan on the market. It works on a different serotonin receptor-5-HT1F-so it doesn’t constrict blood vessels at all. That means it’s safe for people with heart disease. But it comes with a big downside: it makes you feel drugged.In clinical trials, 19% of people taking lasmiditan felt dizzy. Nearly 10% had tingling or numbness. Over 7% felt so sleepy they couldn’t function. One Reddit user wrote: "Reyvow made me feel drunk without alcohol." That post got 147 upvotes. Others said they couldn’t drive, couldn’t work, couldn’t even watch TV for hours.
The FDA requires a warning: don’t drive or operate machinery for at least 8 hours after taking it. That’s longer than most people can afford to be out of commission. Fatigue, muscle weakness, and nausea are also common. In head-to-head trials, triptans were better at reducing pain at 2 hours. Lasmiditan didn’t beat them.
It’s not useless. For people who can’t take triptans and don’t want to wait for gepants, it’s an option. But it’s not a first-line drug. Experts like Dr. Rami Burstein from Harvard say its sedating effects limit its usefulness. If you need to get back to your day quickly, this isn’t the choice.
Which One Is Safest?
A major 2021 study of over 46,000 people compared all three classes. The results were clear:- Ditans had the highest risk of side effects-almost 3 times more than placebo.
- Triptans came next, with a moderate increase in adverse events.
- Gepants had the lowest risk-close to placebo levels.
When it comes to cardiovascular safety, gepants win. Triptans are off-limits for many. Ditans are safe for the heart but too sedating for daily life.
Here’s the real-world picture: triptans are still the most prescribed because they’re cheap, fast, and familiar. But gepants are rising fast. They’re not perfect-but they’re the closest thing we have to a safe, effective, non-sedating option.
What You Should Know Before Choosing
Not all side effects are drug reactions. Sometimes, what feels like nausea or dizziness from the medication is just the migraine itself. The Medical Letter points out that fatigue and weakness are part of the migraine attack. It’s easy to blame the pill when it’s the headache.Also, don’t mix medications. Triptans should never be taken within 24 hours of dihydroergotamine. That combo can cause dangerous blood vessel narrowing.
If you’re on other meds, check for interactions. Gepants can build up in your system if you take certain antibiotics or antifungals. Lasmiditan should be avoided if you have a seizure history-though actual cases are rare.
Long-term safety data is still limited. Only rimegepant has two years of follow-up data. The rest? We’re still watching.
Real People, Real Choices
On Drugs.com, triptans average 6.4 out of 10. Gepants? 7.1. Ditans? Just 5.8. That’s not just numbers-it’s people who tried them and walked away.One woman wrote: "Sumatriptan works within 30 minutes and gets me back to normal." That’s the dream.
Another: "Nurtec took longer, but I didn’t feel like I’d been hit by a truck afterward." That’s the new standard.
And one man on Reddit: "Reyvow knocked me out for six hours. I missed my kid’s recital. Won’t do it again." That’s the cost.
There’s no one-size-fits-all. But if safety and function matter as much as speed, gepants are the smartest bet for most people. Triptans still have their place-for those without heart risks who need instant relief. Ditans? Save them for when nothing else works, and you’re willing to sit still for half a day.
What’s Next?
A new intranasal gepant called zavegepant finished its final trials in 2023. It works in under an hour and has a side effect rate lower than placebo. It’s not on the market yet, but it’s coming. And it’s another sign that the future of migraine treatment is moving away from vasoconstriction-and toward clean, targeted relief.For now, your best move? Talk to your doctor. Bring your symptoms, your triggers, your job demands, your fear of side effects. There’s no perfect pill. But there is a best one-for you.
Are triptans dangerous for your heart?
Triptans can narrow blood vessels, which is why they’re avoided in people with heart disease, uncontrolled high blood pressure, stroke history, or migraines with aura. They’re not dangerous for healthy people, but if you have any cardiovascular risk factors, your doctor will likely recommend something else.
Can you take gepants if you’ve had a stroke?
Yes. Gepants don’t affect blood vessels the way triptans do. They’re considered safe for people with a history of stroke or heart disease. That’s why they’re now a preferred option in guidelines for those patients.
Why does lasmiditan make you feel so tired?
Lasmiditan works on serotonin receptors in the brain that affect alertness and coordination. That’s why dizziness, sedation, and brain fog are so common. It’s not just a side effect-it’s how the drug works. That’s also why the FDA requires an 8-hour driving restriction.
Do gepants work as fast as triptans?
Not quite. Triptans usually reduce pain within 30 to 60 minutes. Gepants take 60 to 90 minutes. But they last longer-up to 48 hours-and have far fewer side effects. For many, the trade-off is worth it.
Can you take these medications every day?
Triptans should be limited to no more than 10 days a month to avoid medication-overuse headaches. Gepants like rimegepant are approved for both acute and preventive use-up to 18 doses a month. Lasmiditan is only for acute use and should be limited to once per day and no more than 9 days a month.
Is there a new migraine drug coming soon?
Yes. Zavegepant, an intranasal gepant, completed its final trials in 2023. It works quickly, avoids the heart risks of triptans, and has a low side effect profile. It’s expected to be available in 2025 and could become a top choice for people who don’t like pills or need faster relief than current gepants offer.
What to Do Next
If you’re still on triptans and they’re causing chest tightness, dizziness, or you’ve had to stop because of side effects, talk to your doctor about switching. If you’re avoiding meds because you’re scared of risks, gepants might be your answer. And if you’ve tried lasmiditan and felt like you were drugged? You’re not alone-and you don’t have to go back.Keep a log: when your migraine hits, what you took, how long it took to work, and how you felt afterward. That’s the best tool your doctor has to find the right fit.
The goal isn’t just to kill the pain. It’s to get your life back-without trading one problem for another.
