Naratriptan

In this section
Does it work?
What is it?
How can it help?
Why should it work?
Can it be harmful?
What's the evidence?

Does it work?

Yes. Naratriptan will help if you have a migraine attack. It helps as many as two-thirds of the people who take it.¹ It can also decrease your chances of needing to take other painkillers, and it can stop your headache coming back within 24 hours.

Naratriptan seems to have fewer side effects than similar drugs such as sumatriptan.

What is it?

Naratriptan is a type of drug known as a triptan. It works in a way that is similar to a chemical in your brain called serotonin. Like serotonin, naratriptan makes the blood vessels in your brain narrower. And this can stop your brain feeling the pain from an attack, at least partly.

The brand name is Naramig.

How can it help?

There is good evidence that naratriptan can help get rid of a migraine attack.^{1 2 3}

• Naratriptan can make a migraine attack better within two hours to four hours. It does this for as many as 2 in 3 people who take it.¹
• Even if your attack is very bad, naratriptan will probably make it milder and more manageable.
• If you take naratriptan, your migraine attack is less likely to come back within 24 hours, and you may not need to take any other painkillers. Naratriptan can also help with other symptoms, including nausea and being extra-sensitive to lights or sounds.
• If you have already tried sumatriptan and found that it did not help, one study has suggested that naratriptan might work for you instead.³
• The dose used in the studies was usually 2.5 milligrams.

A study looking at all the triptans available at the time (2007) found that they all helped to get rid of the pain within two hours, or made it much milder, compared to taking a dummy (placebo) drug. But only sumatriptan and rizatriptan worked better than a placebo drug within half an hour.⁴

Why should it work?

Like other triptans, naratriptan acts like a chemical in your brain called serotonin. It binds to your cells at specific sites called serotonin receptors, rather like a key being put into a lock.

Naratriptan helps to treat migraine attacks in three main ways.

• When you have an attack, the blood vessels in your brain open up (dilate). This means there is more blood flowing through them. Researchers think this is what causes the pain of attacks. Naratriptan corrects the changes in blood flow and makes the blood vessels narrower.
• Secondly, it blocks nerves from releasing chemicals that cause blood vessels in your brain to open up.
• Thirdly, it blocks the release of chemicals that carry pain messages between different parts of your brain.

All of these effects work together to help you feel better.

Can it be harmful?

All triptans can have side effects although they are usually mild and do not last long.²

• The most common side effects are pins and needles and feelings of warmth in different parts of the body.
• Less common are feeling dizzy or flushed or getting neck pain and stiffness.
• You can get more worrying side effects like feeling confused and drowsy but these are far less common.
• Some people get chest pain or tightness but this is not very common.

However most studies of naratriptan have found that people taking a dummy treatment for comparison (a placebo) have the same rate of side effects as people taking the drug.² So it's not certain that naratriptan is the cause of these side effects.

In one study that looked at 643 patients, no one stopped taking naratriptan because of side effects.¹

Other studies have found that naratriptan has fewer side effects than sumatriptan or zolmitriptan.²

If you have heart disease, you should not take this medicine. It can make your blood vessels narrower and your heart disease worse. If you have risk factors for heart disease, like high blood pressure, your doctor might want you to take some heart tests before using this medicine to see if it is safe for you.⁵

Triptans and antidepressants

If you take naratriptan (or any other triptan) together with one of the groups of medicines called selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-noradrenaline reuptake inhibitors (SNRIs), there's a chance you could get a condition called serotonin syndrome.⁶ SSRIs and SNRIs are types of antidepressants. They are treatments for depression and some other mental health problems. SNRIs are sometimes called selective serotonin-norepinephrine reuptake inhibitors.

Serotonin syndrome happens when you get too much serotonin in your body. It can be fatal. All SSRIs and SNRIs increase the amount of serotonin in the body. Names (and brand names) of SSRIs and SNRIs include:

• citalopram (Cipramil)
• duloxetine (Cymbalta)
• escitalopram (Cipralex)
• fluovoxamine (Faverin)
• fluoxetine (Prozac)
• paroxetine (Seroxat)
• sertraline (Lustral)
• venlafaxine (Effexor).

The symptoms of serotonin syndrome are:

• Feeling restless
• Rapid changes in blood pressure (you may not notice anything when this happens)
• A rise in your body temperature
• Feeling jittery
• Feeling like you might be sick
• Vomiting
• Diarrhoea.

The chances of getting serotonin syndrome are highest when you start treatment with one of these medicines in addition to one you're already taking, or the dose of one of them is increased.

If you get any of the above symptoms you should see your doctor or go to an emergency department straight away.

What's the evidence?

What's the evidence for naratriptan?