Sumatriptan alternatives: what works and when

If sumatriptan didn’t help or you can’t take it, you still have good choices. Some options act fast for attack relief, others aim to prevent attacks. Below you'll find clear, practical alternatives, how they differ, and quick tips for talking with your doctor.

Fast-acting acute options

Other triptans: These are in the same family as sumatriptan and often work similarly. Rizatriptan tends to act faster for many people, zolmitriptan and eletriptan are other common choices, and naratriptan usually works slower but lasts longer. If you had side effects or short relief with sumatriptan, trying another triptan is a reasonable next step—many people respond to one triptan when another fails.

Lasmiditan (a "ditan"): This drug treats acute migraine without causing blood vessel tightening. That matters if you have heart disease or high blood pressure and your doctor advised against triptans. Expect drowsiness and dizziness, so don’t drive for at least 8 hours after taking it.

Gepants (ubrogepant, rimegepant): These are oral pills for acute migraine that also don’t constrict blood vessels. Ubrogepant works for single attacks; rimegepant is approved both for acute use and, in a different dosing schedule, as a preventive. They’re useful if triptans aren’t safe or didn’t help.

Non-prescription options: High-dose NSAIDs like naproxen or ibuprofen can work well for mild to moderate attacks, especially early. Combining an NSAID with an anti-nausea medicine (metoclopramide) can help with vomiting or stomach upset. Always follow dosing guidance and check interactions with other meds.

Preventive choices and devices

CGRP monoclonal antibodies: Monthly or quarterly injections (erenumab, fremanezumab, galcanezumab, eptinezumab) reduce attack frequency for many people with frequent migraines. They’re prescription-only and often covered by insurance if you meet criteria.

Botox injections: OnabotulinumtoxinA is an option for chronic migraine (15 or more headache days a month). It’s given every 12 weeks by a trained provider and can noticeably cut headache days for many patients.

Neuromodulation devices: Devices like transcutaneous supraorbital nerve stimulators (Cefaly) or noninvasive vagus nerve stimulators (gammaCore) can help reduce attacks or treat them when they start. They’re drug-free and useful if you prefer non-medication options.

Practical tips: Distinguish acute vs preventive goals before switching. Keep a headache diary to show your doctor attack timing, triggers, and what you tried. Ask about side effects, driving or work restrictions (important with lasmiditan and some gepants), and insurance coverage. Don’t mix triptans with gepants or ditans without medical advice.

Want a plan? Bring your diary and a list of medications to your provider. If you have heart disease, tell them—some drugs are safer than others. With the right match, most people find effective relief even when sumatriptan fails.