What Is the Medicine for Migraines Up the Nose? Your Guide to Intranasal Treatments

October 10, 2025 •

5 min read

For individuals suffering from acute migraine attacks, especially those with associated nausea and vomiting, nasal sprays offer a fast-acting, non-oral alternative for relief. Knowing what is the medicine for migraines up the nose can be a game-changer, as these specialized medications deliver treatment directly to the bloodstream via the nasal passages for quicker symptom control than traditional pills.

Quick Summary

This guide covers the main intranasal medications used to treat acute migraines, including triptans like sumatriptan and zolmitriptan, the CGRP antagonist zavegepant, and dihydroergotamine (DHE). It explains their mechanisms, compares their features, and outlines their benefits for patients who require rapid symptom relief, addressing concerns like nausea and vomiting during an attack.

Key Points

Intranasal Medication Bypass: Nasal sprays for migraines bypass the stomach, making them ideal for patients experiencing nausea or vomiting and providing a faster onset of action.
Triptans are Vasoconstrictors: Sumatriptan (Imitrex®, Tosymra®, Onzetra®) and zolmitriptan (Zomig®) work by narrowing blood vessels in the brain and are contraindicated in patients with cardiovascular disease.
CGRP Antagonists Work Differently: Zavegepant (Zavzpret™) is a newer option that blocks the CGRP molecule and is suitable for patients with cardiovascular risks who can't take triptans.
DHE for Rescue Treatment: Dihydroergotamine (Migranal®, Trudhesa™) is an ergot alkaloid that can be used for attacks unresponsive to other treatments, but it also carries cardiovascular precautions.
Proper Technique is Key: For optimal absorption, it is important to keep your head upright and avoid tilting it back when using the spray.
Monitor for Risks: All acute migraine medications carry a risk of medication overuse headaches if used too frequently (more than 10 days/month), and NSAID nasal sprays like ketorolac have serious short-term use warnings.

Understanding the Need for Intranasal Migraine Medication

Migraine attacks are often accompanied by severe symptoms that can make taking and absorbing oral medication difficult. Nausea and vomiting are common, and during a migraine, the stomach's emptying process can slow down (a condition called gastroparesis), further delaying the effect of a pill. Intranasal administration bypasses the digestive system entirely, allowing the medication to be absorbed directly into the bloodstream through the rich network of blood vessels in the nasal passages. This provides a faster onset of action, making it a valuable option for rapid-onset attacks.

Types of Intranasal Migraine Medications

There are several distinct classes of medication available in nasal spray or powder form, each with a different mechanism of action. The best option for a patient depends on their specific symptoms, health history, and response to treatment. All of these are abortive treatments, meaning they are used to stop a migraine attack in progress, not to prevent one from starting.

Triptans

Triptans are selective serotonin receptor agonists, which means they work by stimulating serotonin receptors in the brain to constrict dilated blood vessels and reduce the transmission of pain signals.

Sumatriptan: This was the first triptan on the market and is widely prescribed. It is available as a nasal spray (Imitrex®, Tosymra®) and a nasal powder delivered via a special breath-powered device (Onzetra® Xsail®). Tosymra® is a more recent formulation designed for quicker absorption.
Zolmitriptan: Available as a nasal spray (Zomig®), zolmitriptan is effective for treating migraines with or without aura in adults and adolescents aged 12 and older. It is also known for its rapid action.

CGRP Receptor Antagonists

Calcitonin gene-related peptide (CGRP) receptor antagonists, or 'gepants', represent a newer class of migraine medication. They work by blocking the CGRP molecule, which plays a critical role in migraine pain.

Zavegepant: Known by its brand name Zavzpret™, this is the first CGRP receptor antagonist available as a nasal spray. It offers a fast-acting alternative for patients who may not respond to or cannot use triptans due to cardiovascular contraindications. In clinical trials, it has shown efficacy within 15 to 30 minutes.

Dihydroergotamine (DHE)

Dihydroergotamine, an ergot alkaloid, has been used for many years and is effective for acute migraine treatment, including those with or without aura. It causes vasoconstriction and inhibits the release of inflammatory peptides.

DHE Nasal Spray: Brand names include Migranal® and the newer formulation, Trudhesa™. Trudhesa™ uses a specialized delivery device to reach the upper nasal cavity, leading to faster and more efficient absorption compared to older DHE nasal sprays.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAID nasal sprays are less common for direct migraine treatment but may be used off-label. They reduce pain and inflammation by blocking cyclooxygenase (COX) enzymes.

Ketorolac (Sprix®): This nasal spray is primarily indicated for short-term management of moderate-to-severe pain but is sometimes prescribed for acute migraine attacks. It is important to note that it is not specifically FDA-approved for migraines and is limited to short-term use (up to 5 days) due to side effect risks.

Comparison of Intranasal Migraine Medications

To help differentiate the options, here is a comparison of the main intranasal medications for acute migraine treatment:


Medication Type	Mechanism of Action	Onset of Action	Suitable For Patients With Nausea/Vomiting?	Precautions/Contraindications
Triptans (Sumatriptan, Zolmitriptan)	Selective serotonin receptor agonists that constrict blood vessels and block pain signals.	Fast; as quick as 15-30 minutes for relief.	Yes; bypasses the GI system for faster absorption.	Cardiovascular disease, uncontrolled hypertension, history of stroke. Serotonin syndrome risk with certain antidepressants.
CGRP Antagonists (Zavegepant)	Blocks the CGRP molecule, preventing it from causing pain and vasodilation.	Fast; as quick as 15 minutes.	Yes; non-oral delivery is ideal.	Fewer cardiovascular risks compared to triptans and DHE, making it a good alternative. Hypersensitivity to components.
Dihydroergotamine (DHE)	Ergot alkaloid that causes vasoconstriction and inhibits inflammatory neuropeptides.	Onset can vary; often used for later-stage attacks.	Yes; can be effective for attacks that have progressed.	Cardiovascular disease, uncontrolled hypertension, peripheral vascular disease, severe liver or kidney disease. Cannot be used within 24 hours of triptans.
NSAIDs (Ketorolac)	Non-steroidal anti-inflammatory that inhibits COX enzymes to reduce pain.	Fast; relief within 20-30 minutes.	Yes; non-oral delivery bypasses nausea.	Short-term use only (max 5 days) due to risk of heart attack, stroke, and stomach bleeding. Contraindicated with other NSAIDs.

Benefits of Intranasal Delivery for Migraine

Choosing a nasal spray can offer significant advantages over other migraine treatments, particularly in certain circumstances:

Rapid Action: Absorption through the nasal mucosa is much faster than oral ingestion, providing quicker relief, which is crucial during a severe or fast-onset migraine.
Overcoming Nausea/Vomiting: Nasal sprays are an ideal solution for patients who experience migraine-related nausea or vomiting, which can make it difficult to keep oral tablets down.
Late-Stage Migraine: For migraines that have progressed and are unresponsive to initial treatment, some intranasal options like DHE can be effective as a 'rescue' medication.
Avoiding Injections: Nasal sprays offer a less invasive, self-administered alternative to injectable medications, making them more comfortable and convenient for many patients.

Potential Side Effects and Precautions

Like all medications, intranasal migraine treatments can have side effects. Common ones include nasal irritation, unusual taste, dry mouth, and drowsiness. However, serious side effects are also a possibility.

Cardiovascular Risks: Triptans and DHE cause blood vessel constriction and should not be used by patients with a history of heart disease, stroke, or uncontrolled high blood pressure. A thorough cardiovascular evaluation is necessary before prescribing these medications.
Serotonin Syndrome: A rare but potentially life-threatening condition called serotonin syndrome can occur when triptans are combined with certain antidepressants (SSRIs or SNRIs).
Medication Overuse Headache: Using any acute migraine medication more than 10 days a month can lead to rebound headaches. Keeping a headache diary can help track usage.
NSAID Risks: Ketorolac use is limited to 5 days due to the risk of serious cardiovascular events, kidney damage, and gastrointestinal bleeding.

How to Properly Use a Migraine Nasal Spray

Proper technique is essential to ensure maximum absorption and effectiveness. While instructions vary slightly by brand, here are general guidelines:

Gently blow your nose to clear the nostrils before use.
Remove the protective cap from the device.
Hold the device upright and close one nostril by pressing on it with a finger.
Insert the tip of the nozzle into the other nostril, angling it slightly outward. Keep your head upright; tilting it back can cause the medication to drip down your throat, reducing its effectiveness.
Breathe in gently through your nose while pressing the plunger firmly to release the spray.
Keep your head level and breathe gently for 10-20 seconds to aid absorption. Avoid sniffing forcefully.

Conclusion

Intranasal medications offer a rapid and effective solution for treating acute migraines, especially for those with co-occurring symptoms like nausea and vomiting. The options available, from traditional triptans and DHE to newer CGRP antagonists, provide a range of choices depending on a patient's individual needs and health considerations. Due to the potential for serious side effects, particularly cardiovascular concerns with triptans and DHE, it is crucial to consult a healthcare provider before starting any new treatment. Your doctor can help determine the safest and most effective medication for your specific situation. For more details on migraine management, the American Migraine Foundation offers a wealth of resources and information.

Frequently Asked Questions

Intranasal migraine sprays generally start working faster than oral tablets due to rapid absorption through the nasal passages. Relief can begin in as little as 15 to 30 minutes, significantly faster than the 30-60 minutes typical for oral medication.

Zavegepant, sold under the brand name Zavzpret™, is a newer nasal spray that is the first of its kind in the CGRP antagonist class. Unlike older medications, it works by blocking a specific molecule involved in migraine pain, offering an alternative for those with cardiovascular risks.

No, most migraine-specific nasal sprays like triptans (e.g., Sumatriptan, Zolmitriptan), CGRP antagonists (Zavegepant), and DHE are available only with a prescription from a healthcare provider. Some nasal NSAIDs like ketorolac (Sprix®) are also prescription-only.

Patients with a history of heart disease, stroke, or uncontrolled high blood pressure should not use triptan or DHE nasal sprays, as they cause blood vessel constriction. A newer option like the CGRP antagonist nasal spray, zavegepant, is often a safer alternative for patients with cardiovascular risks, but you should always consult your doctor.

Common side effects include nasal or throat irritation, a strange or unpleasant taste, dryness in the mouth, nausea, and dizziness. The specific side effects can differ depending on the medication.

To ensure maximum effectiveness, blow your nose gently beforehand. Insert the nozzle while keeping your head upright and angle it slightly outwards. Breathe in gently while spraying and hold your head level afterwards for about 10-20 seconds. Avoid tilting your head back, which can cause the medication to drip down your throat.

Yes, using acute migraine medications, including nasal sprays, too frequently can lead to more frequent and severe headaches over time. Limiting use to fewer than 10 days per month is recommended to avoid this problem.