Migraines can be a crippling condition, robbing you of productive hours, social activities, and overall quality of life. In the UK, triptans are one of the most commonly prescribed classes of medications for acute migraine relief. Among these, sumatriptan and rizatriptan are two popular options available through the NHS and private prescriptions.
While both belong to the same drug family and work in similar ways, there are differences in onset speed, duration of relief, dosage form, and patient tolerance that can influence which is best for you. This guide provides a detailed UK perspective on how they compare, so you can make a more informed decision with your GP or specialist.
What Are Triptans?
Triptans are serotonin (5-HT1B/1D) receptor agonists designed to treat acute migraine attacks, not to prevent them. They work by:
- Narrowing dilated blood vessels in the brain
- Reducing inflammation
- Blocking pain signal transmission in the nervous system
Triptans are not intended for use in cluster headaches unless specifically prescribed for that purpose, and they are not suitable for everyone — particularly people with certain cardiovascular conditions.
Overview of Sumatriptan
Sumatriptan was the first triptan developed and remains one of the most widely prescribed in the UK.
- Common UK brands: Imigran, generic sumatriptan
- Available forms: Tablets, nasal spray, subcutaneous injection
- Typical NHS tablet dose: 50 mg or 100 mg at onset of migraine (maximum 300 mg in 24 hours)
- Onset time: Usually 30–60 minutes for tablets; faster for nasal spray and injection
- Duration: Relief typically lasts 2–4 hours, with some risk of migraine recurrence
Sumatriptan is generally considered effective, widely available, and cost-efficient. It’s often the first triptan a GP will prescribe.
Overview of Rizatriptan
Rizatriptan is a newer triptan and is known for its relatively rapid onset of action.
- Common UK brands: Maxalt, generic rizatriptan
- Available forms: Standard tablets, orally disintegrating tablets (ODT)
- Typical NHS tablet dose: 5 mg or 10 mg at onset of migraine (maximum 30 mg in 24 hours)
- Onset time: 20–30 minutes for ODT; slightly longer for standard tablets
- Duration: Relief usually lasts 4–6 hours; some patients report fewer recurrences than with sumatriptan
The ODT form is especially useful if you experience nausea or vomiting during attacks, as it dissolves without the need for water.
Key Differences Between Sumatriptan and Rizatriptan
| Feature | Sumatriptan | Rizatriptan |
|---|---|---|
| Onset Speed | 30–60 mins (tablet) | 20–30 mins (ODT) |
| Duration | 2–4 hrs | 4–6 hrs |
| Forms Available in UK | Tablet, nasal spray, injection | Tablet, ODT |
| NHS Availability | Widely available | Widely available |
| Risk of Recurrence | Moderate | Possibly lower |
| Cost (Generic) | Lower | Slightly higher |
Effectiveness in the UK Patient Population
NHS clinical guidelines suggest both drugs are effective for migraine relief when taken early in the attack. Some patients respond better to one over the other, which can be due to individual variations in metabolism and migraine pathophysiology.
Research indicates:
- Sumatriptan is highly effective in aborting migraine pain within two hours for many users.
- Rizatriptan may have a slightly higher rate of complete relief at two hours, especially in ODT form, but this can vary.
Ultimately, your GP may recommend trying one, and if it’s not fully effective or causes side effects, switching to the other.
Side Effects and Safety Considerations
Both medications have similar side effect profiles, though individual tolerance varies. Common side effects include:
- Tingling or warmth sensation
- Dizziness
- Drowsiness
- Flushing
- Temporary tightness in the chest or throat (non-cardiac in most cases)
Safety warnings: Neither drug should be used by people with a history of heart attack, stroke, uncontrolled hypertension, or certain forms of vascular disease without specialist clearance.
Which One Should You Try First?
- If speed matters — Rizatriptan ODT may be preferable, especially if nausea is a major symptom.
- If cost and availability matter — Sumatriptan is often the cheaper and more accessible choice on the NHS.
- If recurrence is a problem — Some patients find rizatriptan provides longer relief.
Your GP will likely start you on sumatriptan first due to its established safety profile and low cost, then consider rizatriptan if you don’t respond well.
Practical Tips for UK Patients
- Always take the medication as soon as you recognise the migraine starting (not during aura phase unless advised).
- Keep a migraine diary to track how quickly the drug works and whether the pain returns.
- Discuss alternative triptans with your GP if your current one is ineffective.
- Avoid overuse — limit triptan use to no more than 10 days per month to reduce the risk of medication-overuse headaches.
FAQs
Can I get these medications over the counter in the UK?
No. Both sumatriptan and rizatriptan require a prescription from your GP or specialist.
Which is safer for long-term use?
Neither is meant for long-term daily use. Both can be used repeatedly for acute attacks but should be limited to avoid rebound headaches.
Does rizatriptan work better than sumatriptan?
Some studies suggest a slightly higher efficacy for rizatriptan, but patient response is individual. Many people find sumatriptan works just as well.
Can I switch between them?
Yes, but not during the same migraine attack. Switching is done between attacks under GP supervision.
Are they available on the NHS?
Yes. Both drugs are widely available through NHS prescriptions, subject to GP approval.