Naratriptan

How it works

It activates 5-HT1B/1D receptors, causing cranial vasoconstriction and inhibiting release of pro-inflammatory neuropeptides from trigeminal nerve endings, which relieves migraine.

Prescribing in practice

• It is contraindicated in ischaemic heart disease, uncontrolled hypertension and other significant cardiovascular or cerebrovascular disease because of its vasoconstrictor action.
• Avoid concurrent use with ergot-type medicines and other triptans owing to the risk of additive vasospasm.
• Overuse can lead to medication-overuse headache, so limit frequency of use.

Monitoring

No routine laboratory monitoring is needed, but review cardiovascular risk and headache frequency at follow-up.

Counselling the patient

• Take at the onset of migraine headache rather than during aura.
• Seek urgent help if you develop chest tightness or pain after dosing.
• Limit how often you use it to avoid rebound headaches.

Evidence & guidelines

Naratriptan is an established acute migraine therapy, with triptans recommended by NICE for moderate-to-severe attacks not responding to simple analgesia.