Migraine triptans compared: sumatriptan vs rizatriptan

Medically reviewed by Muhammad A Jalil, Superintendent Pharmacist (GPhC Reg No: 2236161)

Published 2026-08-22 · Clinically reviewed 2026-08-22 · Updated 2026-08-23

Sumatriptan is usually the first triptan prescribed for migraine; rizatriptan suits some people better. How the two compare and how to use them.

Sumatriptan and rizatriptan are both triptans — the standard prescription treatment for migraine attacks — and both work well for most people who suit them. Sumatriptan 50–100 mg is the usual first choice in the UK because it has the largest evidence base, the most formats and the longest track record; rizatriptan 10 mg is absorbed a little faster and comes as a melt-in-the-mouth wafer, which some people find kicks in sooner and is easier to take mid-attack. If one triptan does little for you, another may still work — that is a genuine, well-documented quirk of this family of medicines.

How do triptans work?

During a migraine attack, blood vessels around the brain dilate and pain pathways in the trigeminal nerve fire off inflammatory signals. Triptans act on serotonin (5-HT1B/1D) receptors to calm both processes — narrowing the dilated vessels and damping the pain signalling. They treat attacks; they do not prevent the next one. Taken early and used correctly, they abort or substantially blunt an attack for most suitable patients, working best alongside simple measures: a dark quiet room, fluids, and an anti-sickness tablet if nausea is prominent.

How do the two compare?

	Sumatriptan	Rizatriptan
Usual adult dose	50–100 mg tablet	10 mg tablet or wafer
Noticeable effect from	Around 30–60 minutes	Around 30 minutes
Formats	Tablets, nasal spray, injection	Tablets, orodispersible wafer
Repeat dose	After 2 hours if the migraine returns	After 2 hours if the migraine returns
Notable interactions	MAOIs, ergotamine	Propranolol (dose reduced to 5 mg), MAOIs

Head-to-head trials suggest rizatriptan 10 mg relieves pain at two hours slightly more often than sumatriptan 100 mg, but the difference is modest and individual response varies far more than the averages do. Sumatriptan's nasal spray and injection formats matter when vomiting makes tablets useless — something to raise with your prescriber if attacks come with heavy sickness.

How do I take a triptan properly?

Timing decides most of the result. Take the tablet early, as soon as the headache phase begins — not during the aura (it does not work in that phase) and not after hours of gritting your teeth. If the migraine improves and then returns, a second dose is allowed after at least two hours, within the daily maximum your prescriber sets. If the first dose did nothing at all, a second dose of the same triptan in the same attack rarely helps; treat that attack with painkillers and review your options afterwards. Triptans combine well with an NSAID such as ibuprofen taken at the same time — for many people the pair outperforms either alone.

What if one triptan doesn't work?

Give it a fair trial first: the same triptan across three separate attacks, taken early, because attack-to-attack variation is large. If it genuinely underperforms, switching is standard practice — around one in three people who fail one triptan respond to another. Rizatriptan and sumatriptan are the common first pair to swap between; longer-acting options such as naratriptan or frovatriptan suit people whose migraines relapse late or run long. If several triptans fail, that changes the conversation from "which triptan" to preventives and newer drug classes — a discussion for your GP or a specialist.

The trap to avoid: medication-overuse headache

Using triptans on ten or more days a month — or ordinary painkillers on fifteen or more — can itself cause a daily, dull, treatment-resistant headache layered on top of the migraine. It is one of the most common reasons "my migraines got worse". Keep a simple attack diary; if you are reaching for treatment more than two days a week, that is the signal to discuss prevention rather than to take more acute doses.

Who shouldn't take triptans?

Because triptans narrow blood vessels, they are avoided in people with coronary heart disease, previous heart attack or stroke, poorly controlled blood pressure, and in hemiplegic or basilar-type migraine. Caution and clinical judgement apply with some antidepressants (SSRIs and SNRIs) because of a small serotonin-syndrome risk, and in pregnancy — where sumatriptan has the most reassuring safety data of the family, used when a clinician agrees it is warranted.

Migraine and hormones

Many women find attacks cluster in the days around their period, when oestrogen falls. If your migraines track your cycle, a diary makes the pattern obvious, and options range from timed NSAID or triptan cover through to adjusting how you run your contraception — see our guide on delaying your period for how hormone timing can be shifted. One important safety rule sits nearby: migraine with aura rules out the combined pill because of stroke risk, though progestogen-only and emergency contraception remain safe — covered in our morning-after pill guide.

Frequently asked questions

Which triptan is strongest?

There is no single strongest — rizatriptan edges the averages at two hours, sumatriptan has the widest formats and evidence, and individual response trumps both. The right triptan is the one that reliably ends your attacks.

Can I alternate between the two?

Not within the same attack, and not without guidance. Your prescriber may switch you between attacks to find the better fit, with clear gaps between doses.

Can I take a triptan with paracetamol or ibuprofen?

Yes — combining a triptan with an NSAID or paracetamol is common and often more effective than either alone. Avoid combination painkillers containing codeine for migraine.

Why does my migraine come back a few hours after the tablet works?

Relapse is a known pattern, particularly with shorter-acting triptans. A planned second dose after two hours, or a longer-acting triptan, usually solves it — raise it at your review.

If migraines are interrupting your work, sleep or plans, you can check your eligibility for migraine treatment online. A UK prescriber reviews every consultation and can advise on the right triptan, formats and attack plan for you.