Sumatriptan and rizatriptan for migraine attacks
Sumatriptan and rizatriptan treat migraine attacks. You take a tablet when the headache starts. A licensed clinician reviews your intake and prescribes the generic tablets, and a pharmacy ships them. No referral and no waiting room.
Each fill is nine tablets a month. Triptan use on ten or more days a month for three months meets the definition of medication-overuse headache, where the drug that stops your attacks starts causing them. The nine-tablet cap keeps you under that line. If you routinely need more, you need a daily preventive, and we will say so.
What you get
Oral triptans only. We do not prescribe injectables, nasal forms, opioids or butalbital for headache, ever.
- Sumatriptan 50 mg and 100 mg tabletsas needed
- Start 50 mg at headache onset, repeat once after two hours if needed. We step you to 100 mg at renewal if 50 gave partial relief without trouble. Max 200 mg in 24 hours.
- Rizatriptan 5 mg and 10 mg tablets and ODTas needed
- Start 5 or 10 mg at onset (default 10 mg without flags; the ODT melts on your tongue if you are nauseated). Repeat once after two hours. Max 30 mg in 24 hours. If you take propranolol, the dose is capped at 5 mg per dose and 15 mg a day, and the 10 mg strength is not orderable, because propranolol raises rizatriptan levels.
Class rules we hold to: take it at the onset of pain, not during aura. Never two different triptans, or a triptan plus an ergot, within the same 24 hours. Use it on no more than two days a week as a sustained pattern.
What the evidence says
- [1]
Triptans are first-line for attacks. The American Headache Society Consensus Statement (Headache 2021;61(7):1021-1039) places triptans as first-line acute therapy. The 2024 AHS guidance naming CGRP drugs first-line applies to prevention, not acute treatment, and does not displace triptans for stopping an attack.
- [2]
Sumatriptan versus rizatriptan. Ferrari et al. (Lancet 2001) found rizatriptan 10 mg among the higher two-hour pain-free response rates in triptan comparative meta-analyses. Speed of onset is the usual reason to choose one over the other.
- [3]
Cardiovascular safety. Dodick et al. (Headache 2004;44(5):414-425) is the basis for counting vascular risk factors and requiring in-person cardiovascular evaluation in higher-risk patients before triptan use.
- [4]
The monthly cap. ICHD-3 defines medication-overuse headache as triptan use on ten or more days a month for more than three months. The nine-tablet supply keeps you under that line.
- [5]
Triptans with antidepressants. The AHS position and subsequent cohort data (Orlova et al., JAMA Neurol 2018) show serotonin syndrome from the combination is very low risk. We counsel and monitor; we do not refuse the prescription over it.
Who qualifies
- Age 18 to 64.
- A migraine diagnosis that fits the ICHD-3 screen, or an existing clinician diagnosis plus a positive screen.
- A stable headache pattern, fewer than 15 headache days a month and fewer than ten planned triptan days a month.
- A blood pressure reading from the past six months.
- No red flag and no contraindication from the risks section.
The typical fit: you are diagnosed, you know the drug works for you and the only thing between you and a refill is an appointment.
Known risks and who should not use this
Triptans constrict blood vessels. That is why heart and vascular disease are the main contraindications. The most common side effect people notice is brief pressure or tightness in the chest, neck or jaw after a dose. It usually passes within an hour and is usually not cardiac, but if it recurs with every dose, report it before your next fill.
The conditions below end the intake.
- Heart disease: a heart attack, angina, coronary artery disease, stents, bypass or coronary vasospasm. Triptans are not safe with any of these. Newer migraine drugs (gepants, lasmiditan) do not constrict vessels; ask a clinician about that class.
- A stroke or TIA.
- Peripheral vascular disease or ischemic bowel disease.
- Blood pressure at or above 160/100, or diagnosed hypertension you report as uncontrolled. It needs to be controlled first. We also will not proceed with no reading at all; a free pharmacy machine solves that.
- Hemiplegic migraine (one-sided weakness during attacks) or basilar/brainstem-aura migraine (vertigo, slurred speech, double vision or fainting with aura). FDA labeling contraindicates triptans here.
- An MAO inhibitor now or in the past 14 days (phenelzine, tranylcypromine, isocarboxazid, selegiline, linezolid). Blocks both drugs.
- Severe liver disease (cirrhosis or liver failure) blocks sumatriptan.
- Pregnancy or trying to conceive.
- A severe allergic reaction to a triptan.
Any red flag also stops the prescription and sends you for an exam, because a red flag is a diagnosis question, not a prescribing one. Red flags include a thunderclap headache that peaked in under 60 seconds, headache with fever and a stiff neck, a first-ever headache after age 50, persistent vision changes, a headache that started after a recent head injury, or new neurologic symptoms between attacks.
Flags that route to clinician review rather than block: blood pressure 140 to 159 over 90 to 99, two or more cardiovascular risk factors at an older age, an SSRI or SNRI on your med list (we counsel, we do not withhold), Raynaud's, propranolol (which caps the rizatriptan dose), and ten to 14 headache days a month.
How it works here
You answer an intake. A structured migraine screen (ICHD-3 based), a red-flag screen, and a cardiovascular and medication review. You enter a blood pressure reading from the past six months. A pharmacy machine reading works.
A licensed clinician reviews it. A clinician licensed in your state confirms the diagnosis fits and that no contraindication applies, then prescribes. Multiple cardiovascular risk factors, a near-overuse pattern or an atypical aura route you to a video visit.
The pharmacy ships. Nine tablets ship to your door. After a first-fill check-in, if your pattern is stable you get monthly refills up to a renewal visit.
We order no labs in the standard case. The screen is your history plus a blood pressure reading. The monitoring is your fill pattern and your check-in answers, not bloodwork.
Price
| Clinical visit and prescription | $39 |
|---|---|
| Sumatriptan, 9 tablets per month | $24 |
| Rizatriptan tablet or ODT, 9 tablets per month | $32 |
| Annual renewal visit | $29 |
Generic, FDA-approved tablets. If your pharmacy copay is lower than our cash price, we will say so.
FAQ
Why is my supply only nine tablets a month?
Triptan use on ten or more days a month for three months meets the definition of medication-overuse headache, where the drug starts causing the headaches it once stopped. Nine tablets keeps you under that line. If you need more, that is a signal you need a daily preventive, which is a different and better fix.
My doctor keeps limiting my triptans. Can you give me more?
No. We hold the same nine-a-month cap, for the same safety reason. If you routinely hit the limit, we talk to you about prevention rather than just refilling.
Sumatriptan or rizatriptan, which is faster?
Rizatriptan tends to absorb and act faster for many people and has among the higher two-hour pain-free rates in head-to-head data. Sumatriptan is the long-established standard. Speed of onset and personal response usually decide it.
Can I take a triptan if I am on an SSRI or SNRI?
Yes, in almost all cases. The serotonin syndrome risk from the combination is very low. We counsel you on the symptoms (agitation, fever, sweating, racing heart, tremor) and tell you to stop and seek care if they appear. We do not withhold the prescription over it.
What is the chest tightness people describe after a triptan?
Brief pressure or tightness in the chest, neck or jaw is a common, usually non-cardiac triptan sensation that passes within an hour. It is not the same as cardiac chest pain. But chest tightness that recurs every time you dose gets reported to us and routes to a clinician before your next fill.
Why do you ask for a blood pressure reading?
Triptans constrict blood vessels, and uncontrolled hypertension is a contraindication. We need a reading from the past six months. A free pharmacy machine works; sit quietly five minutes first.
Can I take it during the aura before the headache?
No. Take it at the onset of the headache pain, not during the aura. Taking it during aura does not help and wastes the dose.
Do you treat chronic migraine or cluster headache?
No. This protocol covers acute episodic migraine. Fifteen or more headache days a month is chronic migraine and routes to neurology and a preventive pathway. Cluster headache is out of scope.
What if a triptan does not work for me?
If two different triptans at adequate doses have failed, a third is usually not the answer. We route you to a clinician to reconsider the diagnosis or refer to neurology, rather than swapping triptans indefinitely.
Will you prescribe an opioid or a butalbital combination instead?
No. This platform does not prescribe opioids or butalbital for headache. They worsen the long-term picture and drive overuse headache.
The rest of the catalog
The same rules apply to every medication we carry: a structured intake, a licensed clinician on every review, flat prices and FDA-approved generics only.
From the catalog · Migraine
Start your intake
Answer the intake and a licensed clinician reviews it, usually within one business day.
Clinical content reviewed by [Reviewer name], MD. Last clinically reviewed 2026-06-10.