If you get migraines, you've probably come across triptans. Sumatriptan is a popular choice, but it isn't the only one. Zolmitriptan (Zomig) and rizatriptan (Maxalt) belong to the same drug class and work in a similar way. They differ in dose, format and how quickly they tend to work.
This guide compares zolmitriptan vs rizatriptan, covering onset, side effects and the details that could make one a better fit for you. We've already looked at how sumatriptan compares to rizatriptan on the Health Hub. Here, we go into more detail on the other triptan that's commonly available (zolmitriptan) and how it stacks up against rizatriptan.
How do triptans work?
Triptans treat a migraine attack once it has started. They don't prevent one.1
They work on serotonin receptors (5-HT1B/1D) in your brain. This narrows blood vessels and reduces the release of pain-signalling chemicals around the trigeminal nerve, a major nerve in your head and face.2 Zolmitriptan and rizatriptan both work this way, which is why their side effects are so similar.
Where they differ is in dosing, how your body breaks them down and the formats available in the UK.
Timing matters more than most people expect. Take either medicine once the headache has started, not during the warning "aura" some people get beforehand. It's best to take it as early as you can once the headache begins.2
Taking a triptan before the headache has properly started hasn't been shown to stop it developing.
Zolmitriptan (Zomig) vs rizatriptan (Maxalt): the key differences
Both medicines are taken once the headache starts, but the dose, redosing rules and formats are different. Both are licensed for adults. If you're under 18, a GP can advise on what's suitable.
Zolmitriptan (Zomig)
The standard dose of zolmitriptan is 2.5mg. If that isn't effective enough, your prescriber may increase it to 5mg for future attacks. The maximum is 10mg in 24 hours.2
It comes as a standard tablet, an orodispersible tablet (it dissolves on your tongue, so you don't need water) and a nasal spray.3 The nasal spray can help if nausea or vomiting make swallowing tablets difficult.
Food doesn't affect how zolmitriptan tablets are absorbed, so you don't need to time doses around meals.2
Rizatriptan (Maxalt)
The standard dose of rizatriptan is 10mg. It comes as a tablet or as Maxalt Melt, a wafer that dissolves on your tongue, much like zolmitriptan's orodispersible version.4
Taking propranolol? You will need the lower 5mg dose of rizatriptan, and the two medicines should be taken at least 2 hours apart. Make sure your prescriber knows about everything you take.
Unlike zolmitriptan, rizatriptan isn't currently available as a nasal spray in the UK. So it may not be the best fit if you often feel sick when a migraine hits.
Food slows rizatriptan down too. Taking it with food delays absorption by around an hour, so it tends to work best on an empty stomach.4
If your headache comes back after the first dose has helped, you can take a second dose at least 2 hours later. The most you can take is 2 doses in 24 hours.4
Do not take a second rizatriptan dose if the first one had no effect on that attack. There's no clinical evidence that taking a second dose helps.
Which works faster?
A randomised, placebo-controlled trial of 766 people compared rizatriptan 10mg with zolmitriptan 2.5mg head to head.5
Rizatriptan tended to relieve pain a little sooner. At 2 hours, more people were pain-free (43% vs 36%), and fewer had nausea or sensitivity to light.5 More people on rizatriptan also said they were back to normal function by 2 hours (45% vs 37%).5
Other results were much closer. Headache relief at 2 hours was similar (71% vs 67%). Headaches also came back at almost the same rate within 24 hours: 28% on rizatriptan, 29% on zolmitriptan and 26% on placebo.5 In practice, the gap between standard tablets is small, and both were well tolerated in the trial.5
The Zomig nasal spray is a different story. Some people notice relief within 15 minutes.3 That could matter if your migraines come on fast, or if you tend to be sick early in an attack.
What are the side effects?
Because zolmitriptan and rizatriptan work in the same way, their side effects are similar:
- Fatigue or drowsiness - common with both medicines, especially in the first hour after a dose.5
- Dizziness - reported with both. Do not drive or use machinery until you know how the medicine affects you.5
- Tightness or pressure in the chest, throat or jaw - a known triptan effect, caused by mild narrowing of blood vessels. Tell your pharmacist or GP if this happens.2
- Nausea - can happen with either medicine, though it appeared less often with rizatriptan in the trial.5
- Unusual taste - reported with zolmitriptan nasal spray, as the dose passes the back of your throat.3
If chest pain or tightness is severe, or does not ease, do not take another dose and get medical help straightaway.
Do not take either medicine within 24 hours of another triptan or an ergotamine-type medicine.
Neither medicine should be used if you have a history of heart attack, stroke, uncontrolled high blood pressure or other significant cardiovascular disease.2,4 Both also need care alongside certain antidepressants. Your medical assessment will check for interactions when the medicine is prescribed or dispensed.
Pregnant, trying to conceive or breastfeeding? Speak to your GP before taking either medicine, as the safety data for each is limited.2,4
Which should you choose?
On overall effectiveness, the two are close. So the choice usually comes down to practical things:
- If you're often sick or struggle to swallow tablets during an attack, Zomig nasal spray gives you a non-oral option. Rizatriptan doesn't have one.
- If you take propranolol, you'll usually be prescribed the lower 5mg dose of rizatriptan, because the two interact. Zolmitriptan doesn't have the same dose adjustment, so a standard dose can typically still be used.2,4
- If you often eat before a migraine sets in, zolmitriptan's absorption isn't affected by food. Rizatriptan's is delayed by around an hour.2,4
- If cost matters, standard rizatriptan and zolmitriptan tablets are usually similarly priced. The nasal spray and orodispersible versions tend to cost more.
Tried one triptan without much luck? Switching to the other is a common next step.
Not sure which suits you? Our team or your GP can help you weigh up which of these factors matter most for your migraines.
When should you seek medical advice?
Speak to a pharmacist or GP if:
- You need a triptan on more than 10 days a month, as this can lead to medication overuse headache
- Your migraines change pattern, become more frequent, or you get a new type of headache
- You get chest pain, tightness or shortness of breath after taking either medicine (if it is severe, get help straightaway)
- Neither medicine controls your migraine symptoms after a couple of attacks
Frequently asked questions
How long does rizatriptan take to work?
Rizatriptan tablets start relieving pain within about an hour for most people, with effects building over the following hour or two. Taking it on an empty stomach helps, since food can delay absorption by around an hour.
How long does zolmitriptan take to work?
Zolmitriptan tablets show noticeable relief from around an hour after dosing, with effects continuing to build over the next few hours. The nasal spray version works faster, with early signs of relief within about 15 minutes.
Is zolmitriptan or rizatriptan stronger?
Neither is "stronger" in a straightforward sense. Trial data shows rizatriptan may relieve pain slightly sooner for some people, but headache relief at 2 hours is very similar between the two, and side effects are broadly comparable.
Can you take zolmitriptan and rizatriptan together?
No. You should not take two different triptans within 24 hours of each other. If one isn't working well enough, speak to your GP or our pharmacy team about switching rather than combining them.
Is zolmitriptan or rizatriptan available as a nasal spray?
Zolmitriptan is available as a nasal spray (Zomig Nasal Spray) as well as tablets. Rizatriptan is only available in the UK as a tablet or as Maxalt Melt, a wafer that dissolves on the tongue.
Can you take zolmitriptan or rizatriptan while pregnant or breastfeeding?
Speak to your GP before taking either medicine if you're pregnant, trying to conceive or breastfeeding. Safety data for both is limited, so a doctor needs to weigh this up with you directly.
References
- The Migraine Trust. Triptans. migrainetrust.org
- Electronic Medicines Compendium. Zomig Tablets 2.5mg SmPC. eMC; 2026. medicines.org.uk/emc
- Electronic Medicines Compendium. Zolmitriptan Grunenthal 5mg Nasal Spray SmPC. eMC; 2026. medicines.org.uk/emc
- Electronic Medicines Compendium. Maxalt 5mg and 10mg Tablets SmPC. eMC; 2026. medicines.org.uk/emc
- Pascual J, Vega P, Diener HC, et al. Comparison of rizatriptan 10 mg vs. zolmitriptan 2.5 mg in the acute treatment of migraine. Cephalalgia. 2000;20(5):455-461. doi:10.1046/j.1468-2982.2000.00069.x
This article is intended for informational purposes only and does not replace professional medical advice. Always read the patient information leaflet supplied with your medication and speak to a healthcare professional if you have specific concerns.