You may have heard of using nasal sprays as a potential treatment option for migraine. But what exactly are they and how do they work?
Below, we’ll answer these questions about migraine nasal sprays as well as discuss which ones are currently available. Continue reading to learn more.
There are two types of migraine medications. These are abortive medications and preventative medications.
Abortive medications work to ease the symptoms of an acute migraine attack. You typically take them as soon as you feel the symptoms of a migraine attack coming on.
A 2021 research review estimates that more than 90 percent of people take oral abortive medications for migraine attacks. However, some of these medications are also available in the form of a nasal spray, including:
- the triptans sumatriptan and zolmitriptan
- the ergotamine dihydroergotamine
- the nonsteroidal anti-inflammatory drug (NSAID) ketorolac
On preventative medications
Taking preventative medications can help to prevent migraine attacks from occurring. These medications can be given as a pill or as an injection.
Your doctor may recommend a preventative medication if you have migraine attacks that are frequent, severe, or don’t respond well to abortive medications.
Some examples of preventative migraine medications are:
- blood pressure medications like beta-blockers (propranolol, timolol) or calcium channel blockers like flunarizine
- anti-seizure drugs like topiramate or valproate
- antidepressants like amitriptyline
- calcitonin gene-related peptide (CGRP) monoclonal antibodies like galcanezumab (Emgality) and fremanezumab-vfrm (Ajovy)
Nasal sprays for migraine can offer more rapid relief than oral medications. In fact, a
Generally speaking, medications that are given intranasally can be absorbed more rapidly and effectively than oral medications. What’s the reason for this?
Your nasal cavity contains a high amount of blood vessels. This provides a more direct route for the drug into your bloodstream.
When a drug is directly absorbed into your bloodstream, it avoids being broken down by your digestive system or by your liver during first-pass metabolism. This means that more of the drug is readily available to counteract your migraine symptoms.
Now let’s explore the general mechanisms behind the drugs that are used in migraine nasal sprays.
Triptans are one of the first-line treatments for migraine that’s moderate-to-severe in intensity. Your doctor may recommend a triptan if using NSAIDs or acetaminophen hasn’t been effective for easing acute migraine symptoms.
These drugs bind to certain subtypes of receptors in your brain that are specific for serotonin. Serotonin is a neurotransmitter whose levels are important in migraine.
When a triptan binds to these receptors, it causes blood vessels in your brain to tighten (vasoconstriction). This has the effect of lowering pain signaling and inflammation.
Generally speaking, triptans have replaced ergotamines as one of the primary treatments of acute migraine attacks. Your doctor may prescribe an ergotamine if other medications haven’t been effective at relieving your symptoms.
Ergotamines also bind to serotonin receptors in your brain. This causes blood vessels to constrict and lowers pain signaling. However, they’re also less specific than triptans, which means that they can also cause more side effects.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs inhibit an enzyme called cyclooxygenase (COX) 1 and 2, which blocks the production of prostaglandins. Prostaglandins are chemicals that are important in contributing to pain and inflammation.
Ketorolac, the type of NSAID that’s available as a nasal spray, can be prescribed to help with migraines that cause severe pain. It can also be used as a rescue medication if your primary abortive medication isn’t effective.
The nasal sprays used to treat migraine are sprayed into your nostrils. Whether you’ll need to spray it into one nostril or both nostrils will depend on the product, so be sure to carefully read the product information beforehand.
Additionally, it’s important to spray the medication into your nostril (or nostrils) with your head upright. Tilting your head or sniffing forcibly can cause the medication to go down your throat instead, which can impact your medication’s effectiveness.
There are several migraine nasal sprays that are currently approved by the Food and Drug Administration (FDA). These are:
- Imitrex. Imitrex is a nasal spray of the triptan drug sumatriptan. It was approved by the FDA in 1997 and is indicated for the acute treatment of migraine attacks with or without aura in adults.
- Tosymra. Tosymra is also a nasal spray of the triptan drug sumatriptan. It was approved by the FDA in 2019 and, like Imitrex, is indicated for the treatment of an acute migraine attack with or without aura in adults.
- Zomig. Zomig is a nasal spray of the triptan drug zolmitriptan. It got FDA approval in 2003 and is indicated for helping to treat an acute migraine attack that occurs with or without aura in adults.
- Migranal. Migranal is a nasal spray of the ergotamine dihydroergotamine. It received FDA approval in 1997 and is indicated for acute migraine attack with or without aura in adults.
- Sprix. Sprix is a nasal spray of the NSAID ketorolac. It received its FDA approval in 1989 and is indicated for the treatment of moderate to severe pain in adults.
Advances in nasal spray technology are also occurring. For example, according to Impel NeuroPharma, a new drug application has been submitted to the FDA for INP104, which uses a new technology to deliver a dihydroergotamine nasal spray.
Called precision olfactory delivery (POD), this technology aims to deliver the spray into the upper part of your nasal cavity, where it can be more effectively absorbed into your bloodstream than the currently available nasal sprays.
Questions for your doctor
If you’re interested in a nasal spray for migraine, there are several questions that you may want to ask your doctor first. These include:
- Are nasal spray medications appropriate for managing my acute migraine attack symptoms?
- If so, which type of nasal spray medication do you recommend?
- How would using a nasal spray medication compare to using an oral medication?
- How and when should I take my nasal spray medication?
- How long will it to take for the medication to work?
- What side effects can I expect?
- Are there any drug or supplement interactions that I should be aware of?
- When should I contact you if my migraine nasal spray isn’t effective for alleviating my symptoms?
Nasal sprays can help to ease the symptoms of an acute migraine attack. They can also often work to ease your symptoms faster than oral abortive medications.
Several types of drugs are available as migraine nasal sprays. Some examples include triptans (Imitrex, Zomig), dihydroergotamine (Migranal), and ketorolac (Sprix).
If you’d like to try a nasal spray for migraine, talk with your doctor. They can help you find out if a nasal spray may be beneficial for your acute migraine symptoms, and can inform you of any side effects or interactions to be aware of.