Nasal Sprays and Powders

If you have severe migraine attacks, you want fast-acting relief from the pain and other symptoms. Nasal sprays and powders for migraine deliver drugs intranasally, or through the nostrils. They can start working in only 15 minutes. This can provide relief faster than waiting for a pill to work. Also, for people who have nausea with their migraine attacks, it can be difficult to swallow pills.¹

How do nasal sprays and powders work?

The insides of our noses have many blood vessels. So, when you take a nasal spray or powder, it can enter the bloodstream very quickly. Medicines that you swallow, like pills, take longer to work. This is because they must be broken down by the digestive system.¹

Nasal sprays and powders are meant to be sprayed into the nose with the head upright. Do not sniff or tip your head backward when taking these medicines. If you do, the medicine can go down your throat and into your stomach.¹

The way nasal sprays and powders work depends on the type of drug they contain:^2-6

• Nasal triptans – Triptans can come as sprays or powders. They work by narrowing blood vessels near the brain. This stops pain signals from being sent to the brain.
• Nasal dihydroergotamines (DHEs) – DHEs work by tightening blood vessels in the brain and preventing swelling.
• Nasal nonsteroidal anti-inflammatory drugs (NSAIDs) – NSAIDs work by stopping the body from making the substance that causes pain and inflammation. The US Food and Drug Administration (FDA) has approved nasal NSAIDs to fight pain, but not specifically for migraine.
• Nasal CGRP gepants – CGRP gepants work by blocking a protein called CGRP. Blocking this protein can stop the pain signaling that can be part of migraine disease. This drug may also be called a CGRP receptor antagonist.

Examples

There are several types of nasal sprays and powders used to treat migraine attacks.^2-6

Nasal triptans

Examples of nasal triptans are:^3,4,6

• Imitrex^® (sumatriptan)
• Zomig^® (zolmitriptan)
• Onzetra Xsail^® (sumatriptan)
• Tosymra^® (sumatriptan)

Nasal DHEs

Examples of nasal DHEs are:²

• Migranal^® (dihydroergotamine mesylate)
• Trudhesa^® (dihydroergotamine mesylate)

Nasal NSAIDs

An example of a nasal NSAID is Sprix^® (ketorolac tromethamine).^1,3,5

Nasal CGRP gepants

An example of a nasal CGRP gepant is Zavzpret™ (zavegepant).^1,3

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. But some possible side effects of nasal sprays and powders are:^2-6

• Bad or unusual taste
• Dry mouth, dry nose, or nosebleeds
• Tingling, discomfort, stuffiness, runniness, or irritation in the nose
• Pain, pressure, or tightness in the nose, throat, or chest
• Drowsiness or weakness
• Nausea or vomiting
• Dizziness

These are not all the possible side effects of nasal sprays and powders. Talk to your doctor about what to expect when taking nasal sprays and powders. You also should call your doctor if you have any changes that concern you when taking nasal sprays and powders.

Other things to know

Most of these drugs should not be taken if you are pregnant, may become pregnant, or if you are nursing. Most nasal sprays and powders are not safe to use regularly – for example, more than 10 times a month. The exact limitations depend on the drug.^2-6

It is not safe to take different types of triptans at the same time. You should also not take a DHE within 24 hours of a triptan. It is not safe to take nasal NSAIDs with other NSAIDs, like ibuprofen.^2-6

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.