Zolmitriptan

How it works

It activates 5-HT1B/1D receptors, causing constriction of dilated cranial blood vessels and inhibiting the release of vasoactive neuropeptides from trigeminal nerve terminals.

Prescribing in practice

• Contraindicated in patients with ischaemic heart disease, coronary vasospasm, uncontrolled hypertension, and previous stroke or transient ischaemic attack because of its vasoconstrictor action.
• It is for acute attack relief only and should not be used for migraine prophylaxis; avoid concurrent use with ergot-type preparations and other triptans within the same day.
• Use with caution alongside serotonergic agents such as SSRIs and SNRIs because of the risk of serotonin syndrome.

Monitoring

No routine laboratory monitoring is required, but cardiovascular risk should be assessed before first use and frequency of use reviewed to detect medication-overuse headache.

Counselling the patient

• Take as early as possible once the migraine headache has started; it does not prevent attacks.
• Do not exceed the recommended frequency of dosing, and avoid using on too many days each month to prevent rebound headache.
• Seek urgent advice if you develop chest tightness, pain, or pressure after taking it.

Evidence & guidelines

Triptans are recommended by NICE as a first-line option for acute migraine attacks when simple analgesia is insufficient.