Zolmitriptan is used orally or intranasally for the acute treatment of attacks of migraine with or without aura in adults. The manufacturer states that zolmitriptan should not be used for the management of hemiplegic or basilar migraine or for the prophylaxis of migraine. Safety and efficacy have not been established for the management of cluster headaches.
Efficacy of zolmitriptan administered orally at dosages of 1, 2.5, or 5 mg has been evaluated for the acute treatment of migraine attacks in several randomized, placebo-controlled studies in adults with moderate to severe headaches. In these studies, substantially more patients receiving zolmitriptan achieved a response (mild or no headache pain) 2 hours after treatment than those receiving placebo. In dose-ranging studies, 65 or 60-67% of patients receiving zolmitriptan 2.5 or 5 mg, respectively, achieved a response 2 hours after treatment, compared with 27-50% of patients receiving zolmitriptan 1 mg; headache response at 2 hours in patients receiving zolmitriptan 2.5 mg did not differ substantially from that observed in patients receiving zolmitriptan 5 mg. The drug also relieved manifestations of migraine other than headache (including nausea, photophobia, and phonophobia) and reduced the need for supplemental migraine therapy. In long-term (6-12 months) open-label studies, intermittent zolmitriptan remained effective during subsequent migraine attacks.
Efficacy of zolmitriptan administered intranasally has been evaluated for the acute treatment of migraine attacks in a randomized, placebo-controlled study in adults with moderate to severe headaches. In this study, substantially more patients receiving zolmitriptan intranasally at a dosage of 5 mg achieved a response (mild or no headache pain) 2 hours after treatment than those receiving placebo (69 versus 31%, respectively). The drug also relieved manifestations of migraine other than headache (including nausea, photophobia, and phonophobia) and reduced the need for supplemental migraine therapy. Interim analysis of a similarly designed study supported these findings and showed that substantially more patients receiving intranasally administered zolmitriptan achieved a response 2 hours after treatment than those receiving placebo (70 versus 47%, respectively).
Limited data suggest that 2.5 or 5 mg of oral zolmitriptan is at least as effective as 25 or 50 mg of oral sumatriptan in alleviating the pain associated with migraine 2 hours after treatment.
The US Headache Consortium considers 5-HT1B/1D receptor agonists (e.g., zolmitriptan) an appropriate treatment choice for the acute management of moderate to severe migraine headaches in patients without contraindications to these drugs and recommends use of 5-HT1B/1D receptor agonists, dihydroergotamine, or ergotamine in patients with more severe migraine attacks as well as in patients in whom previous therapy with nonsteroidal anti-inflammatory agents (NSAIAs) or fixed-combination preparations such as acetaminophen, aspirin, and caffeine has been ineffective.
For further information on management and classification of migraine headache,