A few years ago, the phrase “nasal sprays” probably made you think of commercials for allergy medications. Yep, we can picture that bee too. But now that more and more nasal sprays made for treating migraine are hitting the market, you’re likely starting to get curious about how they actually work.
So we did the research and wrote this guide to answer all of your questions.
First thing’s first: How do nasal sprays work in general?
Well, when you spray a treatment into your nose, the medication gets absorbed into the blood vessels in your nostril. After that, it’s just like what happens when you take a pill—the medication travels where it needs to go via your bloodstream. So to answer your question, the mechanics of the spray aside, they treat your migraine similar to the way that an oral pill would.
Why would someone choose to spray a medication into their nose when they could just take a pill and get the same effect?
Nasal sprays usually work more quickly than pills because you don’t have to wait for them to be dissolved and digested by your stomach, a process that slows during a migraine.
Experts call the time it takes for a medication to kick in “time to peak effect,” so nasal sprays have a shorter time to peak effect than tablets do.
For example, if you take a zolmitriptan tablet as soon as you feel a migraine setting in, you could expect to get some relief from your symptoms in about 30 minutes. But if you use Zomig® nasal spray (the same medication, but in nasal spray form), you can get that relief in as little as 15 minutes.
If you’ve experienced a migraine headache, you know exactly what a big difference 15 minutes can make.
The other factor experts consider when choosing what form to recommend is bioavailability, which means how much of the medication enters your blood circulation after you take it. (That’s right—some of what you put into your body never makes it to your bloodstream, which is why vitamins and supplements tend to use higher dosages that you actually need.)
Tablets have the lowest bioavailability, and IV treatments unsurprisingly have the highest. (Fun fact: Orally-dissolving tablets actually take longer to work than standard ones.) Nasal sprays are on the higher end of the spectrum. That means they not only work faster, but are also more efficiently absorbed by your body.
And for people who experience migraine nausea, nasal sprays have an added benefit: You don’t have to swallow them ... or worry about vomiting and wasting medication.
So far, three different types of nasal sprays that can treat migraine have hit the market. They’re all acute treatments (meaning they relieve symptoms but don’t prevent attacks), but they each work a little bit differently.
Like all triptans, nasal triptans relieve migraine symptoms by narrowing overexpanded blood vessels and reducing inflammation in the brain. The nasal triptans that are currently available include Tosymra® (generic sumatriptan) and Zomig® (generic zolmitriptan).
Dihydroergotamine is a formulation of ergotamine, a type of medication that also narrows blood vessels in the brain. (We’ll give you a second to digest those two SAT words.) Ergotamine is a natural product of a certain type of fungus. Medically, it’s used to treat migraines and cluster headaches. Dihydroergotamine is just ergotamine with hydrogen added to make it more potent.
The only drug of this class that’s been approved for migraine treatment so far is Migranal® (generic dihydroergotamine mesylate).
Nasal ketorolac provides a helpful alternative for migraine sufferers with cardiovascular conditions. (It’s risky to take medication that constricts blood vessels, like triptans and DHE, if you have any health conditions that affect your blood circulation.) Ketorolac is a type of non-steroidal anti-inflammatory drug (NSAID), a class of pain relievers. Unlike triptans and DHE, nasal ketorolac isn’t currently FDA-approved to treat migraine, just pain.
One example of a nasal ketorolac you can buy now is Sprix® (generic ketorolac tromethamine).
Like all acute treatments, nasal sprays work best when you take them as soon as you feel a migraine coming on. While you might be tempted to follow the advice the school nurse gave you when you got a nosebleed, you actually shouldn’t tip your head back. Doing so makes the medication drip down your throat and get absorbed by your stomach, which slows down the absorption process. For the same reason, try not to sniff too much while the spray is in your nose.
Since each use should administer a pre-measured amount of medication, you don’t need to worry much about dosage. Just be sure not to use the medication more often than you’re directed to.
One of the benefits of nasal sprays is that they work quickly enough to be a great option for a back-up medication to use when your first-line treatment just isn’t enough. But not all nasal sprays and oral medications can be safely combined.
Regardless of form, different types of triptans can’t be mixed, so don’t use a triptan nasal spray if you’ve already taken an oral triptan. In addition, DHE and triptans also shouldn’t be used together.
On the other hand, NSAIDs and DHE are not only safe to combine, but are also thought to enhance each other’s effect when used together. You can also safely use triptans alongside NSAIDs.
As always, your doctor is the best person to talk to if you have any questions about specific medication combinations.
Like all medications, nasal sprays can come with side effects. Common side effects include:
Talk to your doctor before trying a nasal spray for migraine treatment if you’re pregnant or breastfeeding, and if you have high blood pressure, cardiovascular issues, or kidney problems.
Like other recent innovations in migraine treatment, nasal sprays give you a promising new option to consider when you’re building your treatment plan. For people whose migraines tend to get very severe very quickly, nasal sprays could make a great first-line treatment. And even if that doesn’t describe you, it might not hurt to have a spray as a back-up for your preferred treatment.
The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
Zolmitriptan is an oral medication indicated for the acute treatment of migraine with or without aura in adults and is not used to prevent migraines. Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using this drug while you are pregnant. Tell your doctor if you are breast-feeding. Call your doctor right away if you have allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue, chest pain or chest tightness, signs and symptoms of a dangerous change in heartbeat or heart rhythm like chest pain; dizziness; fast, irregular heartbeat; palpitations; feeling faint or lightheaded; falls; breathing problems. Call your doctor right away if you have signs and symptoms of a stroke like changes in vision; confusion; trouble speaking or understanding; severe headaches; sudden numbness or weakness of the face, arm or leg; trouble walking; dizziness; loss of balance or coordination. Call your doctor right away if you have signs and symptoms of serotonin syndrome like irritable; confusion; diarrhea; fast or irregular heartbeat; muscle twitching; stiff muscles; trouble walking; sweating; high fever; seizures; chills; vomiting. You can read more about zolmitriptan’s side effects, warnings, and precautions here. Full prescribing information for zolmitriptan is available here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: https://www.fda.gov/Safety/MedWatch/default.htm or call 1-800-FDA-1088.
Sumatriptan is an oral medication indicated for the acute treatment of migraine with or without aura in adults and not for the prophylactic therapy of migraine attacks or for the treatment of cluster headache. Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using sumatriptan while you are pregnant. Tell your doctor if you are breast-feeding. Call your doctor right away if you have chest, throat, neck, or jaw tightness, pain, pressure, or heaviness; break out in a cold sweat; shortness of breath; a fast heartbeat; a heartbeat that does not feel normal; or very bad dizziness or passing out. Very bad and sometimes deadly brain blood vessel problems like stroke have rarely happened with this drug. Call your doctor right away if you have weakness on 1 side of the body, trouble speaking or thinking, change in balance, drooping on 1 side of the face, or change in eyesight. You can read more about sumatriptan’s side effects, warnings, and precautions here. Full prescribing information for sumatriptan is available here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: https://www.fda.gov/Safety/MedWatch/default.htm or call 1-800-FDA-1088.
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