Sumatriptan alternatives: Acute and preventive options for migraine

Sumatriptan works well for many people, but it isn’t right for everyone. Maybe it didn’t stop your pain, caused bad side effects, or your heart risk makes vasoconstrictors unsafe. This page lists realistic alternatives for both sudden attacks and long-term prevention, with clear reasons to consider each one.

Options for acute (attack) relief

Other triptans: If sumatriptan didn’t help, trying a different triptan can work. Rizatriptan and eletriptan act faster; naratriptan and frovatriptan last longer and can reduce recurrence. Triptans are all 5-HT1B/1D agonists and can constrict blood vessels, so they’re not for people with heart disease, uncontrolled high blood pressure, or certain vascular conditions.

Gepants (ubrogepant, rimegepant): These are newer oral drugs that block the CGRP pathway. They relieve migraine without narrowing blood vessels, so they’re safer for people with cardiovascular risk. Gepants can be used during attacks and some (rimegepant) also have preventive effects when taken regularly.

Lasmiditan: This is a 5-HT1F agonist that works centrally without vasoconstriction. It can be effective when triptans aren’t an option. Side effects often include dizziness and drowsiness, so avoid driving for a day after taking it.

Nonprescription options: NSAIDs (ibuprofen, naproxen) or acetaminophen plus caffeine can help mild-to-moderate attacks. Combining a simple analgesic with an antiemetic (metoclopramide) sometimes improves absorption and relief.

Preventive choices and other strategies

Oral preventives: Drugs like propranolol, topiramate, amitriptyline, and candesartan reduce attack frequency for many people. They work differently and side effects vary, so pick one with a doctor based on your other health issues.

CGRP monoclonal antibodies: Erenumab, fremanezumab, galcanezumab, and eptinezumab target the CGRP pathway and are given by injection. They’re effective for chronic or frequent migraines and don’t cause vasoconstriction.

Non-drug tactics: Regular sleep, steady meals, hydration, migraine triggers diary, biofeedback, and targeted supplements (magnesium, riboflavin, coenzyme Q10) often cut attack frequency. Botox injections work well for some people with chronic migraine.

Quick practical tips: try one new option at a time, treat early during an attack, and keep a headache diary for 6–8 weeks to judge if a change helps. Watch interactions—MAOIs, SSRIs/SNRIs and triptans raise serotonin concerns; check with your prescriber.

If you have heart disease, stroke history, uncontrolled hypertension, or are pregnant, talk to your clinician before switching drugs. Your doctor can match the safest and most effective alternative to your situation and help with dosing, timing, and side-effect management.