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Generic migraine drug could relieve your pain and save you money

Almost everybody suffers from a headache once in a while, but if the pain is excruciating and disabling, you could have a migraine. Over-the-counter pain relievers are a good first option for knocking out these severe headaches, but if these don't work, it may be time to reach for a stronger class of medicines called triptans.

Figuring out which one of the very expensive (a single pill can be as much as $46) eight triptan medicines is right for you can be, well, a headache. If you suffer from migraines, you're not alone. These types of headaches are fairly common, afflicting about 36 million U.S. adults, and women are three times more likely than men to suffer from them. The symptoms include throbbing pain on one or both sides of the head, nausea, vomiting, and sensitivity to movement, light or noise. Before a migraine attack, some people also experience visual disturbances or auras, such as seeing dots or shapes or flickering lights.

Migraines can be misdiagnosed, and some types of migraines should not be treated with triptans. If you suffer from severe headaches or think you might have migraines, you should see a doctor to get an accurate diagnosis and receive the appropriate treatment.

If diagnosed with migraines, first you may want to reach for nonprescription pain relievers, such as acetaminophen (Tylenol and generics), aspirin, ibuprofen (Advil and generics), naproxen (Aleve and generics), or combination products that contain acetaminophen, aspirin, and caffeine (Excedrin Extra Strength, Excedrin Migraine, and generics).

If those don't work for you, the next step may be a triptan. But which one? Our report considered the evidence for effectiveness, safety, and side effects, as well as cost, and chose one triptan, in several forms, as our Consumer Reports Best Buy Drug:

  Generic sumatriptan tablets, nasal spray, and injectable forms

Sumatriptan is available as a less expensive generic, and studies have found that it is as effective as or better than most of the other triptans when it comes to pain relief. At $14 to $17 per tablet, the pill form will save you money over the other brand-name triptans. The generic sumatriptan nasal spray and injectable forms are more expensive, but these may be good options for those who experience nausea and vomiting when they have a migraine, and can't take a tablet. Another sumatriptan option is the patch formulation, Zecuity, that was approved by the FDA in January 2013, but it is not available as a generic, so it is likely to be expensive.

If sumatriptan doesn't work for you, we recommend trying rizatriptan (Maxalt and generic). Studies indicate it works very well in delivering pain relief within two hours compared with many of the other triptans. But it might be more expensive than generic sumatriptan tablets.

Overall, the available evidence does not clearly show that one triptan has a superior safety profile or a lower rate of side effects than the others. All of these drugs can cause mild to serious side effects. The most common ones are dizziness, numbness, tingling, flushing, sleepiness, and fatigue. Triptans have been associated with rare cases of heart attacks, life-threatening disturbances of heart rhythm, stroke, and death. Certain people should not take triptans, including those who have coronary artery disease or angina (chest pain) or peripheral vascular disease. People who have had a heart attack or stroke, have uncontrolled high blood pressure, or have migraines that are accompanied by weakness or paralysis in an arm or leg, vertigo, ringing in the ears, or speech difficulties should also avoid triptans.

In addition, triptans should be prescribed with caution for those with risk factors for vascular disease, such as men over 40, women over 55, anyone who smokes, has high cholesterol, diabetes, a family history of early heart disease or stroke, and anyone who is significantly overweight.

Triptans: Drug Comparison
CR BEST BUY Generic Name and Dose Brand Name Price per Dose1 Average Monthly Cost1 (If two migraines a month and take one pill or dose per attack) Average Monthly Cost1 (If two migraines a month and take maximum allowed amount per attack, over 24 hours)
  Almotriptan tablet 6.25 mg Axert $34 $67 $269
  Almotriptan tablet 12.5 mg Axert $34 $68 $137
  Eletriptan tablet 20 mg Relpax $38 $76 $303
  Eletriptan tablet 40 mg Relpax $38 $76 $153
  Frovatriptan tablet 2.5 mg Frova $42 $83 $249
  Naratriptan tablet 1 mg Generic $24 $48 $239
  Naratriptan tablet 2.5 mg Generic $12 $23 $47
  Naratriptan tablet 2.5 mg Amerge $40 $80 $160
  Rizatriptan tablet 5 mg Generic NA2 NA NA
  Rizatriptan tablet 5 mg Maxalt $39 $77 $464
  Rizatriptan tablet 10 mg Generic NA2 NA NA
  Rizatriptan tablet 10 mg Maxalt $44 $87 $262
  Rizatriptan dissolvable tablet 5 mg Generic NA2 NA NA
  Rizatriptan dissolvable tablet 5 mg Maxalt MLT $39 $79 $473
  Rizatriptan dissolvable table 10 mg Generic NA2 NA NA
  Rizatriptan dissolvable tablet 10 mg Maxalt MLT $46 $91 $274
Sumatriptan nasal spray 5 mg Generic $38 $76 $610
  Sumatriptan nasal spray 5 mg Imitrex $50 $101 $805
Sumatriptan nasal spray 20 mg Generic $38 $76 $153
  Sumatriptan nasal spray 20 mg Imitrex $48 $95 $191
Sumatriptan tablet 25 mg Generic $17 $34 $276
  Sumatriptan tablet 25 mg Imitrex $38 $75 $600
Sumatriptan tablet 50 mg Generic $15 $30 $119
  Sumatriptan tablet 50 mg Imitrex $39 $78 $312
Sumatriptan tablet 100 mg Generic $14 $28 $55
  Sumatriptan tablet 100 mg Imitrex $41 $82 $163
Sumatriptan cartridge injectable 4 mg/0.5 mL Generic $54 $109 $327
Sumatriptan cartridge injectable 6 mg/0.5 mL Generic $47 $94 $188
  Sumatriptan cartridge injectable 6 mg/0.5 mL Imitrex $120 $240 $479
Sumatriptan pen injectable 4 mg/0.5 mL Generic $49 $97 $291
Sumatriptan pen injectable 6 mg/0.5 mL Generic $50 $100 $200
  Sumatriptan pen injectable kit 6 mg/0.5 mL Alsuma $55 $110 $219
  Sumatriptan pen injectable 6 mg/0.5 mL Imitrex $66 $133 $266
  Sumatriptan needleless injectable 6 mg/0.5 mL Sumavel DosePro $65 $130 $260
Sumatriptan vials injectable 6 mg/0.5 mL Generic $39 $78 $156
  Sumatriptan patch 6.5 mg/4 hours Zecuity NA2 NA NA
  Zolmitriptan tablet 2.5 mg Zomig $41 $81 $326
  Zolmitriptan tablet 5 mg Zomig $45 $91 $182
  Zolmitriptan dissolvable tablet 2.5 mg Zomig ZMT $39 $77 $309
  Zolmitriptan dissolvable tablet 5 mg Zomig ZMT $45 $91 $182
  Zolmitriptan nasal spray 5 mg Zomig $48 $96 $192
  Fixed-Dose Combination Products        
  Sumatriptan/naproxen sodium 85 mg/500 mg Treximet $31 $61 $122
1. Prices per dose and monthly costs are derived from national average retail costs for December 2012 rounded to the nearest dollar. Information is derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Pharma Solutions which is not involved in our analysis or recommendations.

2. NA = Price data not available.