How do you manage patients with good relief but intolerable chest tightness with sumatriptan?

Triptan sensations are described as tightness, often in the chest, which may be accompanied by sensations like burning or tingling. These symptoms are reported in 1-7% of patients compared to 1-2.5% of placebo. They have been investigated with the cause still being unclear, but are not a manifestati...

An abstract I collaborated on was accepted by the European Society of Cardiology reported that patients with angina diagnosed with migraine have a higher prevalence of vasospastic angina, otherwise known as angina and non-obstructive coronary artery disease (ANOCA). We are recommending that these pa...

I have a patient, an internist, who has long-standing chronic migraine with and without aura, with other different seasonal episodes, usually in the fall or early winter, of a form fruste of cluster headache. He was taking sumatriptan 100 mg with excellent relief of his migraines. However, he told m...

Can try a lower dose of sumatriptan. Can try Treximet if available on formulary. Can switch to a different triptan. Naratriptan, frovatriptan are better tolerated. If naratriptan or frovatriptan are less effective can try combining with an NSAID and/or anti-emetic. Ultimately a patient would have to...