Use of both oral and nasal sumatriptan for migraine during a 24-hour period

Objective: Sumatriptan is available in three formulations: subcutaneous injection; nasal spray; and, oral tablet. This study was conducted to determine if sumatdptan nasal spray used initially, could be combined with an oral tablet if necessary, for persistent symptoms or for headache recurrence. Design: Patients were instructed to use sumatriptan 20mg nasal spray for acute migraine and then allowed to use one 50mg tablet at least 2 hours after administration of the nasal spray if the headache did not improve or if it recurred. A second 50mg tablet could be used, if necessary, within 24 hours after the nasal spray and 2 hours after the first tablet. Results: Twenty- four patients were enrolled and 48 headaches were treated. The nasal spray alone relieved 39 headaches (81 percent). Of the nine headaches (19 percent) that did not respond to the nasal spray, four were relieved by one 50mg tablet and three required the second tablet. Only 2 of 48 headaches were not relieved with the nasal spray or the two follow- up tablets. Of the 39 headaches relieved with nasal spray, 15 had no recurrence. In those with recurrence, 17 were relieved with one 50mg tablet, and five required the second tablet. There were no reports of unusual or increased side effects. Conclusions: Sumatriptan nasal spray is effective for migraine and can be combined with sumatriptan tablet(s) for persistent symptoms or for headache recurrence.