There are several different routes of administration for acute migraine therapy.  Especially in patients with migraine upon awakening, severe nausea or vomiting with migraine, or sudden severe pain with migraine, the speed and effectiveness with which a migraine medication works is critical.  I am going to focus on the“triptan” medications since these medications come in injectable form, nasal sprays, oral tablets, and orally disintegrating wafers. 

            Injection therapy is usually the fastest and most effective delivery system.  Although the injection may be painful, patients frequently get used to performing the injections with an automatic device that performs the injection itself.  At the touch of a button, the needle penetrates the skin, delivers the medication, and returns back into its housing. Certain patients prefer injection therapy because of how quickly it works.

            Nasal sprays provide faster relief than oral agents and are a reasonable option for patients with nausea and vomiting, without the invasiveness of an injection.  The disadvantage of the nasal spray is a bitter taste and burning discomfort in the nasal passage.  It is also a little bit of a challenge to learn how to use the nasal spray.  Unlike a saline spray where you tilt your head back and try to get the entire nasal mucosa moist, these nasal sprays should be used with the nose tipped forward so that the medication can be absorbed rapidly in the capillary bed of the nasal mucosa towards the front of the nose.

            Orally disintegrating wafers can be taken without water and melt in the mouth.  This route may provide convenience, especially if water is unavailable.  If the patient has nausea and vomiting or difficulty swallowing tablets, this type of medication is advantageous.  Once dissolved, the medication is swallowed with saliva and absorbed in the gut and does not provide faster relief than conventional oral tablets. 

            Oral tablets may be the easiest to administer; however they have the slowest onset of action due to absorption through the gut. One type of oral tablet is a rapid-release tablet that dissolves more rapidly within the gastrointestinal tract, allowing it to reach a higher blood concentration quickly and provide relief faster. 

            Although not available in United States, rectal suppository is another treatment option for patients with severe nausea and vomiting.  Because absorption is erratic and rectal irritation can occur, most patients prefer not to use this form of treatment.