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 they interact with food and other medicines.
This guide compares zolmitriptan vs rizatriptan, covering speed, 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 put zolmitriptan side by side with 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 nervous system, including on the trigeminal nerve, a major nerve in your head and face. This reduces the pain signals coming from those nerves.1,2 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 handles them and the formats available in the UK.
Timing matters. Take either medicine once the headache has started, rather than during the warning "aura" some people get beforehand. Rizatriptan is licensed for the headache phase of an attack. The zolmitriptan prescribing information advises taking it as early as possible once the headache begins.2,3
If you only get aura without a headache, speak to your GP. Triptans aren't usually prescribed for that.1 And if you need acute medicines a lot, ask your doctor about preventive treatment.1
Triptans ease an attack once it starts. Needing them a lot? That is worth a chat with your GP about prevention.
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.
Zolmitriptan tablets and rizatriptan are licensed for adults. Zolmitriptan nasal spray is also licensed from age 12.2,3,4 Safety in people over 65 hasn't been systematically studied for any of them. If you're under 18 or over 65, a GP can advise on what's suitable.
Never mix triptans. Do not take zolmitriptan and rizatriptan, or any two different triptans, within 24 hours of each other.2,3
Zolmitriptan (Zomig)
The standard dose of zolmitriptan tablets is 2.5mg. If that isn't effective enough, your prescriber may increase it to 5mg for future attacks.2 The nasal spray dose is 5mg, given as a single spray into one nostril.4
The usual maximum is 10mg in 24 hours. A lower limit of 5mg applies for some people, including those with moderate or severe liver problems, or who take cimetidine, fluvoxamine or ciprofloxacin.2
If your symptoms carry on or come back within 24 hours, a second dose can be taken. It must be at least 2 hours after the first, and you must stay within your daily maximum.2,4 Follow your prescriber's instructions on this.
It comes as a standard tablet, an orodispersible tablet (it dissolves on your tongue, so you don't need water) and a nasal spray.4 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.3,5
Some people should take the lower 5mg dose instead. That includes anyone taking propranolol, who should also keep the two medicines at least 2 hours apart. It also includes people with mild or moderate kidney or liver problems.3
Rizatriptan must not be used if you have severe kidney or liver problems.3 Your prescriber will choose the right dose and make sure they know 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 tablets down. Taking them with food delays absorption by around an hour, so they may take longer to work.3 For the wafers, the effect of food hasn't been studied.5
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.3
If the first dose doesn't help at all, do not take another one for that same attack.3
Do not repeat rizatriptan if the first dose did nothing, and do not take two different triptans within 24 hours of each other.
Which works faster?
A randomised, double-blind trial of 766 people compared rizatriptan 10mg with zolmitriptan 2.5mg. Each person treated a single migraine attack.6
Rizatriptan tended to bring pain freedom sooner, but that difference wasn't statistically significant. At 2 hours, more people on rizatriptan were pain-free (43% vs 36%) and back to normal function (45% vs 37%).6
Headache relief at 2 hours was similar (71% vs 67%). Both medicines worked better than placebo and were well tolerated.6 This is one trial from 2000, so it doesn't show that one tablet works better for everyone.
Zolmitriptan nasal spray offers a non-oral option. Its prescribing information says the first signs of relief appear within 15 minutes of a dose.4 It wasn't part of the trial above, so there's no head-to-head comparison with rizatriptan. But it could suit you if you tend to feel sick early in an attack.
One trial can't crown a winner. Both worked well compared with placebo, so your health, other medicines and format all matter.
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.2,3
- Dizziness - common with both. Do not drive or use machinery until you know how the medicine affects you.2,3
- Tightness or pressure in the chest, throat or jaw - common with both. It isn't always a heart problem, but it can occasionally be a sign of a serious reaction, so do not take another dose until you've had medical advice.2,3
- Nausea - common with both.2,3
- Unusual taste - very common with zolmitriptan nasal spray.4
Speak to your GP or pharmacist if side effects bother you or don't settle.
Call 999 immediately if you develop sudden chest pain or pressure that does not go away, spreads to your arm, neck or jaw, or comes with breathlessness or sweating. Do not take another dose.
Neither medicine is suitable for everyone with heart or circulation problems. Both are ruled out for certain conditions, such as heart disease, a past stroke or mini-stroke, and some types of high blood pressure. The exact lists differ slightly between the two.2,3
Heart, blood pressure or stroke history? Say so before you start, because a triptan may not be suitable for you.
Some antidepressants matter here too. Rizatriptan must not be taken with an MAOI antidepressant, such as moclobemide or phenelzine, or within 2 weeks of stopping one.3 Zolmitriptan has a lower maximum of 5mg in 24 hours if you take an MAO-A inhibitor such as moclobemide.2
Both also need care with SSRI and SNRI antidepressants, such as sertraline or venlafaxine.2,3 Either way, a prescriber needs to check whether a triptan is suitable for you.
Ergotamine-type medicines need spacing from both triptans. Wait at least 24 hours after ergotamine before taking a triptan, and at least 6 hours after a triptan before taking ergotamine.2,3
Pregnant, trying to conceive or breastfeeding? Speak to your GP before taking either medicine, as the safety data for each is limited.2,3
Tell your prescriber about your medical history, including heart and circulation problems, blood pressure, liver or kidney problems and any allergy to triptans. Mention everything you take too, including over-the-counter medicines and herbal remedies such as St John's wort.2,3 Some conditions or medicines mean you'll need extra review or a different treatment.
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, zolmitriptan nasal spray gives you a non-oral option. Rizatriptan doesn't have one.
- If you take propranolol, the recommended rizatriptan dose is lower (5mg), because the two interact. Zolmitriptan doesn't need the same dose adjustment.2,3
- If you have liver or kidney problems, both medicines need a prescriber's review. Rizatriptan has a lower dose for mild or moderate problems, and zolmitriptan has a lower daily maximum for moderate or severe liver problems but needs no kidney adjustment.2,3
- If you take an MAOI antidepressant, rizatriptan isn't suitable. Zolmitriptan has its own restrictions with some MAOIs, so a prescriber will need to review this.2,3
- If you often eat before a migraine sets in, zolmitriptan tablets aren't affected by food. Rizatriptan tablets are delayed by around an hour.2,3
If one triptan hasn't worked well for you, a different one may help.1 Tell your prescriber which you've tried, at what dose and what happened.
Triptans are only for migraines that have been properly diagnosed. If you haven't had a diagnosis from your GP, speak to them before starting treatment.2,3
Mention any reaction you've had to a triptan before, such as chest tightness, palpitations, flushing or a rash, so your prescriber can take it into account.
One triptan not suiting you doesn't mean none will. What matters is giving your prescriber the full picture.
Not sure which suits you? A pharmacist 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 take a triptan on 10 or more days a month, as doing this for 3 months or more can lead to medication overuse headache.7
- Your migraines change pattern, become more frequent or much worse, 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 or does not go away, call 999)
- Neither medicine controls your migraine symptoms after a few attacks
Chest pain after a dose, or a new type of headache? Do not wait it out. Get medical advice.
Call 999 or go to A&E if you have a headache and any of the following:8
- It started suddenly and is extremely painful
- You have numbness or weakness in your body or face
- You are finding it difficult to speak, balance, walk or remember things
- You are drowsy or confused, or you have lost your vision
- You have had a seizure
- You have had a head injury within the last 3 months
- You have a rash that does not fade when a glass is rolled over it
- You have a very high temperature, a stiff neck, or bright lights are bothering you
Frequently asked questions
How long does rizatriptan take to work?
Rizatriptan tablets can start easing migraine pain within 30 minutes, though it can take up to 2 hours to feel a clear difference. Food can delay absorption by around an hour, but there’s no need to wait for an empty stomach. Taking it early in the headache matters most, so take it as directed once the pain starts.
How long does zolmitriptan take to work?
Zolmitriptan tablets can bring noticeable relief within about an hour for people who respond to them. Zolmitriptan 5mg nasal spray is a non-oral alternative, with early signs of relief reported within 15 minutes in clinical studies. That makes it worth considering if nausea or vomiting makes swallowing tablets difficult.
Is zolmitriptan or rizatriptan stronger?
Neither is “stronger” in a straightforward sense. In a head-to-head trial, slightly more people were pain-free at 2 hours on rizatriptan, but headache relief at 2 hours was very similar between the two. Side effects are broadly comparable too, so the better choice usually comes down to practical things like format, food and other medicines you take.
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 in the UK as tablets, orodispersible tablets that melt on your tongue and a 5mg nasal spray. Rizatriptan comes as standard tablets or orodispersible tablets, including Maxalt Melt. There’s currently no UK-licensed rizatriptan nasal spray.
Can you take zolmitriptan or rizatriptan while pregnant or breastfeeding?
Speak to your GP or midwife before taking zolmitriptan or rizatriptan if you’re pregnant, planning a pregnancy or breastfeeding. The safety evidence isn’t the same for both medicines, so a healthcare professional needs to weigh up the risks and benefits with you before recommending either one.
References
- The Migraine Trust. Triptans. The Migraine Trust; 2024. migrainetrust.org
- Grunenthal Ltd. Zomig Tablets 2.5mg: Summary of Product Characteristics. Electronic Medicines Compendium; 2023. medicines.org.uk/emc
- Organon Pharma (UK) Limited. Maxalt 5mg and 10mg Tablets: Summary of Product Characteristics. Electronic Medicines Compendium; 2025. medicines.org.uk/emc
- Grunenthal Ltd. Zolmitriptan Grunenthal 5mg Nasal Spray: Summary of Product Characteristics. Electronic Medicines Compendium; 2026. medicines.org.uk/emc
- Organon Pharma (UK) Limited. Maxalt Melt 10mg Oral Lyophilisates: Summary of Product Characteristics. Electronic Medicines Compendium; 2025. 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
- National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management (CG150). NICE; 2025. nice.org.uk
- NHS. Headaches. NHS website; 2024. nhs.uk
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.