Sumatriptan alternatives: what to try when sumatriptan isn't right

If sumatriptan didn't work for you or you can't take it because of heart issues, there are several other choices. Some act like triptans but with different speed or side effects. Others work in a totally different way and can help both attacks and prevention. Below I’ll walk you through practical options and when to ask your doctor about them.

Other triptans — similar but slightly different

Triptans are a family. If sumatriptan caused bad side effects or didn’t stop your migraine, you might try another member of the group. Rizatriptan usually works fast and many people get quick relief. Eletriptan also hits fast and can be strong when sumatriptan fails. Zolmitriptan and almotriptan are gentler for some folks, and naratriptan or frovatriptan last longer — good for long migraines or menstrual attacks. Keep in mind all triptans share a risk with heart disease, so they’re not safe if you have uncontrolled high blood pressure, stroke history, or certain cardiac conditions.

Non-triptan acute options and preventive choices

If you need something that avoids the cardiovascular risks of triptans, consider these groups. Gepants (ubrogepant, rimegepant) are oral drugs made for acute migraine relief; they’re good if triptans aren’t an option. Lasmiditan is another acute pill that works differently and doesn’t stress the heart, but it can cause dizziness and you shouldn’t drive for 8 hours after taking it. For fast pain relief at home, high-dose NSAIDs like naproxen or ibuprofen can help early attacks — pair them with an antiemetic if nausea is severe.

For prevention, CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab) lower attack frequency and have fewer daily side effects than older preventives. Atogepant is an oral preventive from the gepant family. If medications aren’t right or you want non-drug methods, neuromodulation devices and lifestyle changes (sleep, hydration, trigger tracking) can cut attacks down.

Practical tips: try a new acute med early in the attack, because timing matters. Don’t mix two triptans or a triptan with a gepant without your doctor’s okay. Watch for medication overuse — using acute meds too often can make headaches worse. If cost or insurance is a concern, ask your provider about samples, generics, or patient support programs.

When to see a specialist: if you get more than four disabling migraines a month, meds stop working, or you have unusual symptoms. A headache specialist can tailor a plan — choosing an acute option, starting prevention, or recommending tests. Talk openly about heart history, pregnancy, and other meds so the choice fits your body and lifestyle.