Ditans for Migraine

Ditans are a newer option for the acute treatment of migraine attacks with or without aura in adults. Ditans may be offered to people who cannot take triptans or do not respond to triptans or other migraine therapies.¹

How are ditans different from triptans?

One important difference is that triptans constrict blood vessels, and ditans do not. Ditans may be an option for people with diseases that affect the heart or blood vessels. Triptans may not be safe for this group of people.²

This difference is based on how the drugs work. Triptans and ditans relieve migraine by affecting the serotonin receptors. But there are many subtypes of serotonin receptors. Triptans bind to the 5-HT1B and 5-HT1D receptor subtypes. Binding to these receptors constricts blood vessels throughout the body, which might not be safe for people with heart disease.²

How do ditans work?

Ditans bind to the 5-HT1F receptor subtype. These receptors are found mainly within the brain and prevent the trigeminal nerve from releasing CGRP (calcitonin gene-related peptide).^3,4

CGRP is a small protein that sends signals in the brain. It has an important role in migraine pain. By binding to 5-HT1F, ditans prevent the release of CGRP and reduce the pain processes in the brain.⁵

Examples

As of 2023, only 1 ditan has been approved by the US Food and Drug Administration (FDA) to treat migraine:

• Reyvow^® (lasmiditan)⁶

Reyvow is a controlled substance and must be prescribed by a healthcare provider.⁶

What are the possible side effects?

The most common side effects of ditans include:⁶

• Dizziness
• Sleepiness
• Numbness
• Feeling tired
• Tingling

These are not all the possible side effects of ditans. Talk to your doctor about what to expect when taking a ditan drug. You also should call your doctor if you have any changes that concern you when taking a ditan drug.

Other things to know

Before starting treatment with ditans, tell your doctor if you have:⁶

• Liver problems
• High blood pressure
• A low heart rate
• An allergy to lasmiditan

Ditans may make you tired. Do not drive or operate machinery for at least 8 hours after taking a ditan. You should also avoid alcohol and other medicines that make you drowsy while taking a ditan.⁶

There is not enough data to know if ditans are safe to take while pregnant or breastfeeding. Before starting treatment with a ditan, tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding. They can help you decide if a ditan is right for you.⁶

Ditans may interact with other medicines, especially:

• Propranolol or other medicines that can lower your heart rate
• Any medicines that can increase your blood pressure
• Any medicines that make you sleepy
• Anti-depressant medicines called:
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Tricyclic anti-depressants (TCAs)
  • Monoamine oxidase inhibitors (MAOIs)

Before beginning treatment for migraine, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.