A couple of messges in today's new posts raised questions about triptan safety. I was surprised that a search in PubMed on the topic reveals nothing of note from 2004 to today. I can only assume that clinical experience is not raising serious concerns or broadly experienced problems as triptans have developed long term usage.
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Neurol Sci. 2004 Oct;25 Suppl 3:S119-22.
Cluster headache: symptomatic treatment.

Torelli P, Manzoni GC.

Headache Centre, Section of Neurology, Department of Neuroscience, University of Parma, Via Gramsci 14, I-43100 Parma, Italy. paolatorelli@libero.it

The clinical management of cluster headache (CH) attacks requires a symptomatic treatment that is rapidly effective in resolving or significantly reducing symptoms. First-choice drugs for the symptomatic treatment of CH are subcutaneous sumatriptan at a dose of 6 mg and 100% oxygen inhalation at a rate of 7 l/min for no more than 15 min. Sumatriptan acts by suppressing pain and the accompanying autonomic phenomena, with no substantial differences in its mechanism of action between episodic and chronic CH. The drug can be used for prolonged periods without loss of efficacy or safety and its side-effects are generally mild or moderate. Oxygen inhalation has a number of advantages over drug therapy: it is free from side-effects, has no contraindications--unlike sumatriptan, it can be used in patients with cardiac, cerebral or peripheral vascular disease and with kidney, liver or lung disease--acts rapidly and can be administered several times a day. Its disadvantages are that it is scarcely practical and may induce a "rebound effect". Sumatriptan nasal spray, zolmitriptan and dihydroergotamine nasal spray are scarcely effective. After the introduction of sumatriptan, ergotamine tartrate has been relegated to a secondary role in the symptomatic treatment of CH. Among other non-drug and topical drug treatment options, hyperbaric oxygen therapy and the intranasal application of 10% cocaine hydrochloride and 10% lidocaine in the sphenopalatine fossa have also proved effective.

PMID: 15549518 [PubMed]

Bob Johnson wrote on Mar 28^th, 2009 at 9:37am:

--unlike sumatriptan, it [02] can be used in patients with cardiac, cerebral or peripheral vascular disease and with kidney, liver or lung disease-- and may induce a "rebound effect"

I'd say the major safety concerns are outlined by it's list of contraindications.

People were dying from the shots early on and as they added to the list of contraindications the deaths ended?
Of note, the high incedence of smokers with clusters, the list pertains to a pretty high number of cluster sufferers.

One other problem I see is that with misdiagnosis still a regular problem (for many doctors and I can't figure out why its so hard for them) some people that shouldn't use them, are. People with BAM sometimes are misdiagnosed as clusters and they should not be using triptans.

I also found it interesting that this PubMed article listed 02 as having rebound problems but not triptans. I know those studies were probably just being getting published around the time this article was written, but I think some were done prior to this.

JM2C
Bobw

The clinical management of cluster headache (CH) attacks requires a symptomatic treatment that is rapidly effective in resolving or significantly reducing symptoms. First-choice drugs for the symptomatic treatment of CH are subcutaneous sumatriptan at a dose of 6 mg and 100% oxygen inhalation at a rate of 7 l/min for no more than 15 min.


Are you sure that the 6mg dosage mentioned here is correct? I was perscribed 100mg tablets (as well as a steroid taper for 12 days) At the time, I was in the midst of the very worst part of the cycle. ...The sumitriptan did the trick; taking them at the very first sign of the severe pain killed the attack in 20 min rather than the normal 2 hrs...

OK, I think I might get it now...Sumitriptan injection = 6mg, Sumitriptan tablets =100mg
kinda makes me nervous about the vast difference in mg's.....
any concurrence on this?

Different forms of the same med will having different dosing. No problem with the data you have.

In this case, the route of administration makes a big difference in how much of the med can effectively be utilized by your body.

As Bob mentioned, the difference is in the route of administration. I have found a 3mg injection works in about 6-7 minutes, whereas a 100 mg tablet rarely works (in the time the attack would be over anyway).

If you can get your doctor to prescribe injections there are a few flavors:

Statdose two pack. I hate them because the needles hurt and leave blood spots on your shirt sleeve. It is also hard to split them when you are in excuciating pain and can't think straight.

Imitrex 6mg/0.5ml vials with 0.5ml insulin syringes. Easy to split into two 3 mg doses, and needles don't hurt or leave blood spots.

Generic sumatriptan 6 mg/0.5 ml with 0.5 ml insulin syringes. Same as above, except costs less.

The last two aren't normally stocked by pharmacies so must be prepared for a 1-2 day delay when filling a new prescription.