Which non-prescription option is recommended when?: Over-the-counter triptans

Triptans should only be given as self-treatment to adults with doctor-diagnosed migraines (see figure). So these people usually already have experience using prescription triptans. If the triptans you have taken so far have been effective, you should try to choose a triptan that is similar in duration and onset of action (see the box “Onset and duration of action of triptans”).

If a patient wants the quickest possible onset of action with a prolonged duration of action, studies have shown that taking sumatriptan with naproxen is particularly effective. Migraine patients who often suffer from recurrent headaches often benefit best from long-acting triptans such as naratriptan, as headache recurrence is less likely. Rizatriptan, an oral triptan with a rapid onset of action, will soon be available in the OTC combination. The change in prescribing regulation, which was necessary to exempt rizatriptan from prescription requirements, came into effect on May 9, 2024. However, there are no similar preparations on the horizon yet. Manufacturers must first apply for the necessary changes, for example regarding advertising and indication, to the Federal Institute for Medicines and Medical Devices (BfArM). Rizatriptan is particularly useful for patients with short, severe migraine attacks. Since taking it after eating delays the onset of action of rizatriptan by about an hour, it should be taken on an empty stomach if possible.