Migraine Medications: Triptans, Gepants, and Ditans Safety Compared

When a migraine hits, speed and effectiveness matter-but so does safety. Many people reach for triptans because they work fast, but what if the chest tightness, dizziness, or fatigue they cause is worse than the headache? Newer options like gepants and ditans promise fewer side effects, but they come with their own trade-offs. Understanding the real safety differences between these three classes isn’t just academic-it can change whether you can drive home, go back to work, or even sleep at night after taking your medicine.

Triptans: Fast but Not Always Gentle

Triptans like sumatriptan, rizatriptan, and almotriptan have been the go-to for acute migraines since the 1990s. They work by narrowing blood vessels around the brain and blocking pain signals. That’s why they often relieve pain in under an hour. But that same mechanism is also why they carry risks.

Up to 15% of users report tingling or numbness. About 8% feel a heavy, squeezing sensation in the chest-so common, many patients think they’re having a heart attack. In reality, it’s just the drug tightening blood vessels. That’s why triptans are off-limits for people with heart disease, uncontrolled high blood pressure, or a history of stroke. Even if you’ve taken them before without issue, your risk changes over time.

Some formulations make things worse. Subcutaneous sumatriptan causes injection-site pain in 40% of users. Nasal sprays leave a bitter aftertaste for about a quarter of people. Fatigue and dizziness are reported in up to 14% of users. A 2021 analysis of 64 clinical trials found triptans had a higher rate of any adverse event compared to newer drugs like gepants. And while serious heart events are rare, they do happen-especially when triptans are taken too often or combined with other vasoconstrictors like ergotamines.

On Drugs.com, triptans average a 6.4 out of 10. Half of users say they work well. The other half say they won’t take them again because of the side effects. One user wrote: "Felt like my heart was in a vise. Never again."

Gepants: The Quiet Contender

Gepants-like ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT)-work differently. Instead of constricting blood vessels, they block a protein called CGRP that triggers migraine pain. Because they don’t affect blood vessels, they’re safe for people with heart conditions who can’t use triptans.

The side effects? Mild. Nausea happens in only 4-6% of users. Drowsiness affects about 2-4%. Allergic reactions are rare-less than 0.1% for rimegepant. In the same 2021 study, gepants had the lowest risk of any adverse event among all acute migraine treatments. That’s why the American Headache Society now recommends them as a preferred option for patients with cardiovascular risks.

They’re not perfect. They take longer to work-usually 1 to 2 hours compared to triptans’ 30 minutes. But they last longer. Rimegepant’s half-life is 10-12 hours, meaning relief can stretch into the next day. That’s a big plus for people who get rebound headaches or need to stay functional after treatment.

On Drugs.com, rimegepant scores 7.1 out of 10. Users praise the lack of chest pressure. One wrote: "Took Nurtec after years of triptans. No tightness. Just slower. Worth it."

There’s one catch: rimegepant can interact with strong CYP3A4 inhibitors like ketoconazole or grapefruit juice. These can spike drug levels in your blood. Always check with your doctor if you’re on other meds.

Ditans: Effective, But With a Heavy Cost

Lasmiditan (Reyvow) is the only ditan on the market. It targets a different serotonin receptor (5-HT1F) than triptans, so it doesn’t constrict blood vessels. That makes it theoretically safer for people with heart issues. But here’s the twist: it hits the brain harder-and that’s where the problems start.

In clinical trials, 18.8% of people taking lasmiditan 100mg felt dizzy. Nearly 10% had tingling or numbness. Over 7% felt extremely sleepy. Others reported vertigo, poor coordination, and even mental fogginess. In one trial, 2.8% had cognitive changes-things like trouble focusing or memory lapses. These aren’t minor inconveniences. They’re disabling.

The FDA requires a black box warning: Do not drive or operate machinery for at least 8 hours after taking Reyvow. That’s not a suggestion. That’s a rule. A 2021 study showed driving performance was impaired even five hours after dosing. Many users report feeling "drunk without alcohol," as one Reddit user put it. That post got over 140 upvotes-and dozens of comments from people who couldn’t work, care for kids, or even walk straight after taking it.

On Drugs.com, lasmiditan averages just 5.8 out of 10. Over 60% of negative reviews mention dizziness or sedation. For someone who needs to get back to a job, school, or parenting duties, that’s a dealbreaker. Experts like Dr. Rami Burstein at Harvard say it’s not a good first-line option for most people. It’s reserved for those who can’t use triptans or gepants-and who can afford to be out of commission for half a day.

Comparing the Three: What the Data Shows

Who Should Take What?

There’s no one-size-fits-all. Your best choice depends on your health, your job, and what you’re willing to tolerate.

• If you have heart disease, high blood pressure, or stroke risk → Choose gepants. They’re the only class safe for you. Rimegepant is even approved for both acute and preventive use.
• If you need fast relief and have no heart issues → Triptans still win. They work faster and are cheaper. Almotriptan and frovatriptan tend to have fewer side effects than others in this class.
• If you’ve tried triptans and hated the chest tightness, but can’t wait 2 hours → Gepants are your best bet. They’re slower but gentler.
• If you’ve tried everything else and still get severe migraines → Lasmiditan might help-but only if you can afford to be sedated for half a day. Avoid if you have seizures, take sedatives, or drive for work.

Many people switch from triptans to gepants and never go back. One patient told me: "I used to take sumatriptan three times a week. I’d be wiped out for hours. Now I take Nurtec. It takes longer, but I can still talk to my kids after. That’s worth it."

What’s New and What’s Coming

The migraine treatment landscape is changing fast. Gepants are gaining market share-up from 2% in 2020 to 28% in late 2023. Triptans still lead at 62%, but their dominance is slipping as more people trade speed for safety.

Zavegepant, a new intranasal gepant, just finished phase 3 trials. It works in under an hour and has a side effect profile similar to oral gepants-no vasoconstriction, no driving restrictions. It could be approved in 2025.

Long-term safety data is still limited. Only rimegepant has two years of data showing it’s safe for regular use. Other gepants and ditans need more time. But for now, the trend is clear: patients and doctors are choosing options that don’t leave them feeling wrecked after the headache is gone.

Final Takeaways

Triptans are fast. Gepants are safe. Ditans are powerful-but come with a heavy price.

If you’re still using triptans and feeling chest pressure, dizziness, or fatigue after every dose, you’re not alone. But you don’t have to keep tolerating it. There are better options now. Ask your doctor about gepants if you have heart concerns. If you’re young and healthy, triptans may still be fine-but don’t ignore the side effects. And if you’re considering lasmiditan, make sure you can safely take 8 hours off from everything.

The goal isn’t just to stop the pain. It’s to get back to your life-without the medication making you feel worse than the migraine did.